Here's why you haven't heard from me much lately

I'm midway through week 5 of 6 for my gyn oncology rotation. It is an amazing expereince and I am growing a lot as a surgeon and a doctor (maybe a piece about how those are 2 different things in my mind is warranted). The hours are long and the cases are tough, medically and emotionally. I will pull back the curtain a little if I can, but for now the experience alone is enough for my mind, I find I am lacking in the capacity to both complete my days and write about them.

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I have some things I'm writing about work, but they require more polish and time than I have right now. This rotation is something of a bear. I hope I can write more about it later this year when I do it again. The pieces are getting my attention, slowly but surely. I will post them here when I have them fit for consumption. Until then, some insights about my life:

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A year ago today, I had an interaction with my husband that left me bereft, stressed out and incapable of functioning. Because it was the weekend, I had a few days to gather my senses, talk to a friend and figure out how to get back on track. It made me realize how close to the brink of Not Coping I was and made me realize that things were not what I needed and frankly hadn’t been that way for a long time. It was the day I realized that I had done everything I could do to save my marriage and that, in its current state, it was unsalvageable. It was still many months before my marriage ended officially, but this weekend was when I realized that I had bent as much as I could for this partnership and I needed to unbend so that I didn’t snap in two. This was the weekend I resolved not to engage in the same destructive conversations without an arbiter present to protect me. It was many weeks before my partner even wanted to engage in these conversations again, and then months after that before he put the work into finding space for us to talk according to my safety requirements. That time gave me space to build my own thoughts and expectations about how those conversations could be different.

A year ago I spent the morning crying in the gym parking lot, talking to friends and mustering the courage to go do some self-care (Thank the gods for BodyCombat!). Even though I’m not much of one for anniversaries, this anniversary is sticking out for me. A year ago it was my birthday.

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I have reached a point in my training and within this rotation that I feel actually helpful. I am able to make and implement plans that only sometimes get undone or amended by my chief. I know where to find information to answer questions I don’t have the answer to that are necessary for me to be as helpful as I’m managing to be. This post is not about all the things I need to learn and that I can’t do yet. This post is about how I’m getting better at my job. They may make a doctor out of me yet.

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My kids do this thing where they both agree that XYZ situation or scenario would make me flip my cap, or that I would behave in an extreme helicopter-y way - like interrogate their friends or accompany them to something or forbid their participation in an event or activity. I know that I have spent a long time being a “no” person in their lives, being the strict one but also the reliable one, the “psychological parent” as the case may be. I’m trying to decide if they actually hold an impression of me as overprotective and unreasonable as they project me to be, or if it is some sort of weird mind game. I’m going to run with the theory that they are using these conversations as a way to acknowledge my commitment to them and my hard work supporting them emotionally, financially and logistically. Yeah, let’s run with that!

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It is truly amazing to me that the organ I see when I do cesarean sections is the same organ as the little thing I see in women in their 60s or older when they are having laproscopic hysterectomies. The former have huge, beefy red, muscular organs that bleed a LOT, have significant bulk for cutting into them and sewing them up while the latter are teeny tiny cute little, pale organs smaller than palm of my hand.

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I’m trying really hard not to be a bitter divorcée, both because I strongly desire not to be a cliche in my life but also because I find bitterness to be a fruitless experience that only harms myself. I’ll be angry or frustrated, but I don’t want to be bitter. But as I get older, life gets less surprising. Like discussing with some of my colleagues a recent article in an Ob/Gyn magazine (NOT a journal) about how few het married woman Ob/Gyns feel that their husbands do a bulk or equal share of the household duties. Or when I have an interaction with my ex wherein I feel I have been punished and rewarded based on how he feels about my part of our texts (the only way we conversate these days). I hate that I need him to give me money, and I hate that we are fighting about it. We have a pretty simple agreement, but since when is money simple? So yeah, angry, frustrated, feeling powerless and generally swearing off men as romantic interests. How does that differ from being bitter? I don’t know. It may not. Maybe I just need to embrace bitterness the way I embraced being angry. It felt better afterward. But I don’t think that is the right move with bitterness. I need to think a little bit more about what it means to me to be bitter. I feel like it is a state of being that will impede my emotional health but I’m not certain yet. Maybe it is just me naming emotions I’ve already been having, perspectives from which I’ve been viewing the world for some time. Huh, maybe I am already a bitter divorcée and I just didn’t know it.  

I'll give you 3 guesses which side I'm on...

The hospital that houses our residency program is a powerhouse in Western North Carolina. Several regional hospitals have shut down their L&Ds and we are getting those patients traveling here for their deliveries. But the system itself is not objectively huge, more of a normal sized fish in a tiny pond. WNC is not that big compared to major urban centers of the region or even of our state.

They are big enough, however, to cause some trouble for an insurance company that is trying to strong-arm their contract renewal negotiations. I’ve seen this sort of thing happen in other communities I’ve lived in. The contracts don’t get negotiated substantively until AFTER they expire. That leaves people insured by the company (which I won’t name but its initials are BCBS) out in the cold during the process. Reimbursement of many smaller practices in the region will likely be guided by what happens with this conflict.

October 5th was the end of the contract and things are still heating up. Private mudslinging emails aired, giving excuses not to negotiate and blasting the fighting in the local papers. It is a little like Mom and Dad fighting and conveying messages through their children instead of coping like adults. Meanwhile a large portion of the privately insured of WNC are over a barrel.

There was a huge insurance company media campaign against the hospital and eventually someone from the hospital marketing department convinced the powers that be that it was time to hit back. There have been ads, Op Eds, signs posted around the hospital telling their side of things.

And patient care is already being affected. Fewer surgeries scheduled, women about to have babies are trying to figure out where they need to go and how they should navigate the situation. Because they are being told to drive FAR away for the births of their babies and remember what I said about the smaller regional hospitals closing their L&D units? It’s all a mess.

As the intern...

I have something of a writer’s block. I really want to write about residency and the amazing things that are happening in my day but the things I think to write about during the day are hard for me to muster again when I get in front of my computer. I’m doing a lot of thinking about personal things, there’s a lot going on in my life, in how I’m thinking about and reacting to my life. My kids remain brilliant and shining humans, doing such great jobs with the very difficult tasks of being adolescents, having a busy working mother and being in a new school & town. I want so very much to think about and write about what is happening at work but I’m just not in the head space for it yet.

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I just finished week 1 of 6 of the gyn oncology rotation. This is a challenging rotation - we have really sick patients, with lots of co-morbidities (they have more problems than just cancer), they are lots of different ages and at different stages of disease. We spend a lot of time in the OR and we have a lot of management responsibilities for the patients who are on the floor. The is significant learning is in every facet of our day. Interns cover the breast cases, which is fantastic experience that many don’t get in residency.

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I’m on my gyn/onc rotation now, and as the intern, you do a lot of breast cases, which is spectacular experience and a really special part of my residency program.

In the first few days of this rotation I have done breast cases for women ranging from their early 30s to mid 70s. One of the most striking things for me, as an intern surgeon, is the differences in the skin of women at different ages. Not the cosmetic, external differences, but the cellular changes. Cutting and suturing skin of women of different ages is different. With younger women you have to put more pressure on the scalpel to get through the dermis. With older women, the layers are thinner and suturing requires more precision to be certain you are in the correct layers.

All this makes me feel a lot better about aging. I mean, I may not like my wrinkles and the subtle (I like to tell myself) sag that my skin has taken on as time goes by, but it isn’t as if I can do anything about the fact that my collagen is breaking down and the cell layers in my skin are thinner than they were 15 years ago. So yeah, I have wrinkles, and I look like I’ve lived a life that could have raised 2 teenagers, and not have been a teen mother either. And sometimes when I introduce myself as “Larissa, one of the new OB interns” people can’t help but spurt out questions about my life before medicine. “You look old to me, I’m curious about why you don’t match my mental image of ‘intern’, tell me intrusive details about your life.” But it isn’t like I can help it. It isn’t as if there’s something I did to make my skin get thin. It just happens. Time marches on. And sometimes, depending on my mood and the setting and the manners of the person who asks, noting that I’ve got “mature skin” gets you an interesting, funny story about my life. And sometimes it just gets you a funny look and someone who pretends not to understand what you are asking her.

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As an intern, I have to work with a lot of new, different people. Nursing & clinical support staff deal with a new batch of interns every year and you know there are some who are a little tired of the same mistakes, slow technique, unfamiliarity with protocol. I don’t blame them. I”m fed up with my own amateurishness, and I’ve only had to deal with it once and for a few months! Generally speaking, though, the staff are very supportive and positive about helping us to learn to do our jobs. There is, at least in my hospital, a huge culture of respect. I think hope the douchey intern who disses nurses is no longer a real attitude and relegated to being just a tired, Hollywood trope (I’m thinking of that one episode of Grey’s Anatomy that I watched).

And each attending has their own surgery style, preferences and teaching method. Some are socratic, some are sink or swim, some ask you a question and then stare at you blankly while you fumble your way through an answer. Some are really good at giving positive feedback to the fragile ego of new doctors and others give less ‘sandwich’ feedback but when you get a “perfect” or “just like that!” from them, you know you really nailed it. With a rare few, I feel like it might actually physically pain them to say something positive.

And just like any workplace, some people are easier to get along with than others. Some people don’t gel as a pair or a team, others push your most tenderest buttons. I try really hard to see the Shadowself in my tough interpersonal interactions. Maybe there’s something they do that is a little too familiar in my own behavior? Maybe the way I perceive their treatment of me really feeds that negative self-talk I’ve been trying to overcome since the moment it was programmed? What is there that I can learn, change, adapt, in this situation? And I’m also trying really hard not to knee-jerk react. The hypervigilant streak I have is a mile wide and so easily fed just about any human interaction. I’m trying to sit with my feelings about these interactions and not draw conclusions. To approach them with curiosity. Often I am successful. Well, eventually I am successful. Sausages, laws and mature interpersonal reactions are all very messy in the making.