Poop, Glorious Poop: Most of us get past fecal obsession somewhere around second grade, but others of us are not quite so fortunate.

Work life is a bit difficult at the present. Such is becoming a cliche for me, and I feel redundant, guilty, and apologetic for repeatedly reporting my work life as such.

No one is treating me with less than the respect I am due. My working conditions themselves aren't especially arduous.  My coworkers are professional when not outrightly cordial, and they're usually cordial.

I'm finishing up a subinternship that I have already technically fulfilled [and for which I received favorable reviews the first time it came around]  but health issues got in the way of my having given the subinternship what I felt was my very best effort. Instead of taking on an extra specialty by way of clerkship rotation, I elected to put the extra four weeks into another stab [figuratively, not literally; I approach surgery with precision and not with stabbing motions] at at pediatric surgery subinternship. The consensus on the part of my superiors was that the full four weeks usually devoted to a subinternship would be overkill, and that two-and-one-half additional weeks would more than suffice, particularly by virtue of my having passed the rotation with floating if not flying colors.

This all would have been peachy were it not for a major flare-up of ulcerative colitis having chosen this particular time time to rear up [no pun intended] its ugly head.  Some specialties lend themselves to the minor inconvenience of having to quickly excuse oneself and run out of a room to take care of business when a sense op urgency pops up. Surgery is not one of such specialties. Nevertheless, excusing myself is my only option in some instances.

Immodium-type products are far less than optimal for my condition. They typically work too well for me. Most people have the luxury of giving little thought to such issues, but constipation, which can be caused by strong anti-diarrheals, can be not merely inconvenient or uncomfortable, but legitimately dangerous. Constipation carried too far can lead to a condition known as ischemic colitis, less commonly referred to as necrotic colitis. It involves inadequate blood supply to a part of the colon, potentially killing off that part of the colon.  It's not uncommon among the elderly but relatively rare among the younger population.

I encountered my one-and-only  [thus far; knock on wood] case of ischemic colitis when I took a strong anti-diarrheal drug in anticipation of a surgery when I had been experiencing colonic urgency and frequency. I did this without the medical advice of any health professional, which was my first mistake. Even licensed physicians shouldn't treat themselves; medical studentls who do so act with even greater stupidity. Everything still might have been OK had I taken a strong stimulant laxative following the completion of the surgical procedure in which I strongly desired to participate, but I didn't. I functioned under the idea that what comes in must eventually come out, and that constipation is a self-limiting condition.

I was wrong. Twelve days later, following a majoir bleed-out, I learned just how wrong I was. Despite being almost as sick as I ever was in my enitre life (double kidney failure probably left my body in a more ravaged state, but it was a close call between the two) I got off relatively easily, with no permanent damage. I could have suffered all sorts of organ failures in addition to shock and bleeding to death, and probably came within two hours of not surviving. Luck and excellent healthcare were both on my side, and I now live to tell the story.

In any event, my colon is not being especially cooperative in this stint of my medical education. The consensus among my job superiors is that I do not scrub in for a procedure if I feel symptoms coming on. If I feel fine and things change during the course of the procedure, I endure as long as I can, sometiomes making it through the procedure. Sometimes I excuse myself and am then finished for the day and sometimes even for the next day. It's a play it by [r]ear situation. My job superiors are being most gracious in dealing with my infirmity. 

I was able to turn my Hawaii trip into a bit of a working vacation with the cooperation of the hospital professionals there, which gave me the opportunity to scrub in successfully for a few procedures. My only failure there happened right after the erroneous missile alert. Emotional upsets tend to bring on ulcerative colitis flare-ups for me. Still, I completed four procedures while there.

My record here is three completions and one walk-out. During the time I needed off following the walk-out, my SP (supervisiing phsysician) had overheard a discussion between myself regarding a discussion between myself and others concerning the  preparation of a prospective phsysician or physician's assitant in training for the interview process. As the SP's  daughter will join the pool pf medical school applicants next year, it piqued his interest. He has given me the assignment of researching the tiopic among peers and what is available on the Internet, and is giving me credit for my compiliation to compesnsate for any missed time on the job. For this I am most appreciative.

Everything I've discussed here and some of what I have not has created serious doubts as to whether surgery is the ideal option for me as a physician. The correct answer remains to be seen. Fortunately, if my residency option works out as planned, I will finish my program with dual certifications in both general pediatrics and with general and pediatric service certifications (contingent upon sucessful completion of board exams, but standardized exams tend to be my strong suit).

The idea here is that stress compounds my condition. Medical school is stressful. My internship and residency aren't likely to be a walk through Golden Gate Park in broad daylight, either, but the hours of duty in the residency program I plan to rank as my first choice are limited beyond what is customary.  Following the residency, I work however many hours I need to work to pay my bills. I'm optimistic that stress can be managed, and that, if all else fails, I can work as a general pediatrician.

I have another two weeks to strut muy stuff on the sub-internship. Suturing is a particular relative strength for me, and I take every advantage of showing off my prowess in that area. Following the completion of the sub-internship, I have a block of time off. Following the block of time off, I have a single clearkship rotation. I will travel for a portion of my time off, but will return to campus for the all-important Match Day, at which our university holds a ceremeony announcing, among those of us fortunate to have received matches with existing institutions, where we will spend the next phases of our training.  This ceremony is, even more than commencement, the culmination of everything for which we've been working. I'm nervous yet excited and optimistic.