Completion of Medical School, Match Day, Marriage, Medical Specialty, Life!!!

I'm reaching the age where it's not unthinkable to consider marriage, although  I'd be getting WAY ahead of myself to proceed too far into planning it or even thinking about it when I have no likely candidate in mind. A little over a month ago, I at least had a candidate. I wasn't taking his candidacy too seriously, nor was he, apparently, since he broke it off by phone over Christmas vacation. (The two of us were not yet engaged to be married.) My brother continues to remind me that the guy was at least classy enough not to have ended the relationship via text. I would have preferred an in-person break-off, however inconvenient it might have been. However, as much as I hate this statement when anyone else says it, I shall use it myself this once: it is what it is. The guy broke it off by phone. He could have hired an airplane to fly past my ski resort when he knew I would be outside, with a banner trailing the plane, spelling out the words: "We're finished, Alexis. Get over it!" almost in the style someone (his ex Stephanie March insists she had nothing to do with it) repeatedly flew above Bobby Flay at the podium as he attempted to give his speech prior to his star on the Hollywood Walk of Fame being dedicated. The banner trailing the plane disturbing Bobby Flay's ceremony read simply, "Cheater!" Sometimes the laconic approach is best. I couldn't have expressed it better myself.

In any event, I checked out the statistics for medical school students and interns/residents. It seems that, even with statistics for marriage overall showing a decline for individuals in their twenties as opposed to in previous decades) nearly half of medical students at my stage of medical education have already tied the knot. That surprised me, but I found my roster of students in my own cohort and counted. Out of the one-hundred-three students remaining in our cohort (As late in the game as it is, our number may soon drop by one. It seems that one of our members has found herself in warm if not downright hot water. Regardless of any connection the situation may or may no have with me, I'm staying out of it on both sides. I won't plead for mercy on her behalf, nor will I offer any evidence against her unless I am compelled by my superiors to do so, and such seems highly unlikely at this point) forty-nine of the one-hundred-three are presently married. Two are on their second marriages (where in hell do these people find the time for this level of activity?) and five of the presently single cohort member have been divorced. As far as who is currently contemplating divorce or even has filed for such, I haven't the foggiest notion. I'm doing well to know who is even married. I wouldn't know who had been divorced were Celinda not sitting here with me and cluing me in as to the marital status of the respective members of our cohort.  She somehow has time to keep up with such minutiae.  Numerous members of the cohort (even Celinda doesn't know the exact number but she estimates it to between ten and twenty) plan to get hitched during the break between graduation and the start of internship/residency. Interestingly enough, none of our cohort members are married to one another, nor, as far as Celinda knows, are the scheduled upcoming nuptials between any of our cohort members. While I'm the last person who should be providing marital or premarital advice, it would seem to be a wise act for a variety of reasons not to marry a person in one's own graduating medical school class at the same school of medicine, at least while the two are both enrolled in medical school. There's plenty of time later to develop the relationship and to make it legal if doing so seems like a good idea later. 

I find it highly dubious that anyone still reading this actually gives a flying squirrel's rectum about the percentages regarding relationships, though I'll share the numbers anyway because I've always been a math geek. It rounds up very slightly to forty-eight of my cohort mates presently being married. Fifty-two per cent of my cohort mates have been married. Counting all marriages, divorces, and remarriages, fifty-six marriages have taken place among members of my cohort. If we allow the divorced members to skew the statistics -- and it is a clear skew of the statistics -- fifty-four per cent of the members of our cohort have been married. 

One statistic I found interesting though not terribly significant is that -- depending upon whose statistics one chooses to believe, students enrolled in programs leading to degrees in osteopathic medicine have a significantly higher chance of marrying before their final year of formal schooling has been competed. One source I checked had sixty-eight per cent of the  D.O. candidates married by their final semester (or penultimate quarter depending upon the system) while another listed their rate of marriage in the same time period at seventy per cent.

I won't use this time to go into the differences between traditional (sometimes referred to as "allopathic" medicine and osteopathic medicine). Historically, the two evolved from the study of extremely different  forms of medical treatment, with osteopathic medicine focusing heavily upon musculoskeletal adjustment of the body. While  osteopathic medical students continue to receive more treatment in the study of musculoskeletal adjustment than do traditional medical school students, osteopathic medical students now receive considerably more training in areas considered "traditional medicine."  I don't wish to burden anyone with my own prejudices concerning osteopathic medical training, nor do I wish to engage in arguments with anyone concerning the same. I will say (and some will disagree)  that students in osteopathic programs were frequently rejected from traditional medical schools, and I will also say that students enrolled in traditional medical school programs post an average MCAT (Medical Schools Admission Test)score of 31.4, as opposed to the mean score of those enrolled in schools of osteopathic medicine, which is 25.31. Some sources have suggested that acceptance rates as schools of osteopathic medicine are lower than at traditional medical schools. If such is indeed the case -- and I'm not 100% convinced it is -- it would be, in my estimation, in part because students apply to osteopathic medical programs who know they haven't a ghost of a chance at admission to traditional medical programs and that osteopathic medical programs also deal with applicants who have been rejected from all traditional medical school programs to which they applied.

Prospective doctors of osteopathy used to take different board exams (COMLEX) than do doctors of medicine (USMLE). There may have been very legitimate reasons for the different exams. Were I the God of Medical Exams, and particularly if I were in charge of prospective osteopathic physicians and the exams they were given, I would insist upon doctors in both programs taking the same exams. Osteopathic physicians frequently face attitudes of superiority from doctors of traditional medicine. Were I an osteopathic physician, I would welcome the opportunity to demonstrate that my knowledge, at least as measured by a  given test, was equal to or superior to a doctor of traditional or allopathic medicine.  Alleging that one's test is actually more difficult than the test taken by doctors of traditional medicine, even if it happened to be true, which I highly doubt, doesn't cut it as an explanation in the real world. It's similar to most of the private schools in my area (typically the Catholic Schools), which insist on giving the equivalent to Form B, or the test that is offered in the fall, instead of giving its students Form A, or the identical test public school students take in the spring each year.  Private school administrators give all sorts of bogus explanations, sometimes even going so far as to outrightly lie and to say that their students took in the fall the identical test that the public students will take in the spring. Such is blatantly untrue. The test the private school students typically take in the fall is a slightly modified version of one the public school students took the previous spring, usually amended to make it slightly easier because it is given so early in the school year that students haven't had adequate time to recover what they may have forgotten over the summer.  (I use Catholic schools as an example here because it would be an unfair comparison to pit preparatory schools with annual tuition of an absolute minimum of twenty-two thousand dollars against public schools. The two groups of student populations have nothing in common. With Catholic schools, while they have a slight socioeconomic edge over public when considering both mean and median income and the fact that Catholic schools can and do reject anyone they would prefer not to have among their student bodies, it's still close enough to be an almost level playing field. Catholic schools should relish the opportunity to kick the public schools' butts on standardized tests each year. Instead, they give different forms of the test, yet still try to boast of their superior performance despite it being an "apples to oranges" comparison.

I use the two rather unlikely comparisons because in both cases, in my opinion, one group is opting not to take an identical test as the other when it would be a perfect chance, if the claims made by the smaller group in each case have merit, to demonstrate superiority or at least equality. If the osteopathic programs consider that they must test, in addition to the standard medical curricula, the musculoskeletal content covered in their program, they could include an additional test covering those areas, and could require their candidates to pass both exams in order to be eligible to practice medicine. While I will likely work with many doctors of osteopathy during the course of my career, I do not wish to carry a chip around on my shoulder in relation to the supposed superiority of my training as compared to theirs. On the other hand, if I am brought to an emergency room with severe cardiac symptoms, I desire to be treated by a physician who has passed the respective required versions of the USMLE as opposed to the COMLEX with its extra two-hundred questions about musculoskeletal manipulation. I'll now climb off my soap box and return to my discussion of marriage as it relates to medical school and the practice of medicine.

I wouldn't really consider medical school to be exactly a microcosm of society for various reasons. What I would consider it to be is a multicultural, multi-societal, multi-geographical, multi-communal mixing bowl. The percentages of the racial breakdown of our cohort and of the medical school as a whole almost certainly exist on someone's computer and in a file cabinet somewhere, and they're probably being used as I type to attempt to gain additional funding due to a higher-than-average percentage of females, Asians, Africans, members who identify as LGBTQ or whatever is the current acceptable term, individuals with physical disabilities, individuals from backgrounds that would qualifying them as being economically disadvantaged, and individuals who have suffered what someone reading through stacks of applications would consider to have been significant trauma at some point in their lives. 

We, with our widely varying backgrounds, were thrown together into a lecture hall or two or three, and, perhaps most significantly, a human cadaver lab. Before ever being granted access to any actual hospital corridors abutting rooms containing live patients, we bonded over difficult content, demanding professors, and the dissection of cadavers.  It's truly a bonding experience. In some cases it's more of an un-bonding experience. Just as you grow close to some over shared trials, you learn through adversity that there are other individuals in the company of whom you will never spend more than five seconds if you are not required to do so.  A great deal of dating happens between cohort mates, as your dating pool consists largely of those with whom you spend time. A considerable amount of sex also happens. Most of us are at an age at which our hormones are running amok. The sex that happens in closets on Grey's Anatomy isn't entirely a case of Hollywood's attempt at making things more titillating for viewers. It happens, though usually at someone's apartment and not in a hospital supply closet.  Some positions are more comfortable than others, not all hospital supply closets have locking doors, and there's probably more than one reason God or at least someone invented beds.  

Dating practices notwithstanding, practicality ended up leading most of us in different directions when it came to more serious relationships. On Friday, March 16, most of us will learn where we will serve our residencies. Either we can opt out of the program after our initial year [our internship], or the program itself can opt out and invite us to continue our training elsewhere. Regardless, we're contractually committed to any institution with which "the computer" (I'm sure there is more than one computer involved, but it's always referred to simply as "the computer") matches us. We dash all over the nation having interviews while also trying to get views of hospitals and communities. We then submit lists of our preferences of programs in order. The teaching programs at hospitals also rank us in order of their preference. We're assured that the system is fair and that it does not place preference of the institutions above preferences of the students, and that a fair and equal balance exists. I'm convinced that we're not far from knowing exactly how it happens, and the disclosure of how it works will, within a very short number of years, force the system to be "fair and balanced" (another term I've grown to detest but will use it here anyway), but for now, we as students  have no choice but to take the computer's word for it and to take the match that we're given.

For most of us, Match Day is perhaps the most exciting yet simultaneously the most stressful day of each of our respective lives. While we can opt out (or be kicked out) after a year, that's not what most of us anticipate. We assume that our match will be for the duration of our training. That if we aspire to be general surgeons, the next five years of our lives will be spent at that institution. For a few specialties, it's a three-year commitment, but for others it can be six years.
We're stressed about being accepted into a program of our choice. We're anxious about the location. Imagine adding to that the apprehension of where a spouse or prospective spouse might end up in relation to where one's own residency might be. I can't imagine it, which is a reason I've chosen not to become too closely attached to anyone who faces as little control as I do over my immediate future. 

Some of my peers have girlfriends and boyfriends within the cohort. They'll choose whether to break things off cleanly, try to make a long distance relationship work, or somewhere in between. In some cases they may even get lucky and end up at the same institution, or very near. They'll find that they have very little time off, and what time they do have off may not coincide with the time the other has off. Their relationship may soon be history. Or maybe it won't Some relationships succeed against seemingly insurmountable odds.

My brother is in a relationship. His sweetheart is a registered nurse who will soon complete her certification as a nurse practitioner.. If it's what they decide to do, she will be able to travel to wherever he goes. Registered nurses and nurse practitioners can work almost anywhere. My brother and the woman in his life face the same hurdles anyone faces who is either a physician in training or who marries or attempts to maintain a relationship with one. The odds are probably technically against the success of their relationship. Technical odds are beaten every day of the year, though. It's all up to them The world is their oyster, whatever that means.

As for me, as much as the recent breakup hurt, I'm very relieved to be entering this new phase of my life with virtually no encumbrances.  I have a better-than-average chance of ending up where I think I will be matched, and it is my first choice. My plan, assuming I end up where I think I will be, is to spend the full five years there and walk away with the multiple certifications I hope to earn. If the ulcerative colitis situation doesn't improve, which I don't believe will be the case: for once in my life I shall dispense with my usual pessimism and will think positively; while colitis may always be a part of my life to some degree, it will improve, and I will function as a normal person to the degree that the specialty in which I ultimately practice will be a matter of choice and not a matter of default due to health concerns. 

I don't need to place any sort of time limit on a relationship. As it is, I'm barely the age most people are when they begin medical school. and I will have finished up all of my coursework in ten weeks (four of which will be spent on vacation!!!!), and will be graduating in roughly four months. If somewhere in the next few years, I find a person I'd care to share my life with, it will be sublime. If not, I have an astonishing career to which to look forward, I'll earn enough money to travel to exotic locations, and I can date or not as I see fit. Three members of my cohort have made proposals of varying sorts, but all are along the lines of "If neither of us is in a relationship in X number of years, we should meet up and see whether it would work out between us." I haven't said yes or no  to any of them, but if the time is right, I'll explore the options.

There are people who are my age of twenty-three who are working at Burger King while they try to pay off student loans as they try to find some way to use their relatively useless degrees.  And those are the ones who are relatively fortunate. Others have changed their majors four times and haven't yet completed their bachelor's degrees. They, too, are among the lucky ones. Still others are divorced (or never married) with a child or two to support with or without financial help from the child's or children's father(s). (I've vowed to stop using the term "sperm donor" to refer to baby daddies. It's an insult to legitimate sperm donors, who perform a valuable service to society. Thanks, Knotty, for opening my eyes and changing my perspective on that.)

I will very soon have not only my M.D., but a bachelor of science degree in biochemistry that I earned four years ago, in addition to Bachelors of Fine Arts degrees in piano performance, violin performance, and musicology. I didn't originally have the musicology degree, but my music faculty adviser looked over my transcript and noticed that I was a mere two courses short in that degree. I completed the courses online just for the hell of it.  If I really don't like being a doctor, I can probably find something to do with my music degrees. It probably won't pay tremendously well, but there's always busking as a way of supplementing one's income.

Marriage is something that I hope is in the cards for me. I will be cautious. While I don't necessarily wish to be married to another doctor, neither do I wish to be tied to someone who loves my salary more than he loves me. That's not to say I wouldn't consider having a stay-at-home husband for a few years while children were very young if he happened to be really good at it.  However I view it, though, barring some unforeseen tragedy, the possibility of which is so remote that it's pointless to waste time worrying about it, I have lots of time before needing to decide much of anything of consequence, and I have the potential, even without relying on my medical degree,  to earn enough money to live as well as anyone reasonably needs to live. Gold toilets or other features of the Trump Tower or other equally opulent places aren't things I need or even want -- ever.  Marriage to the right person sounds like a wonderful prospect, and I hope it happens for me eventually, but if it doesn't. I'm prepared to create a happy life for myself.

i don't own this video. Thanks to the rightful owner for allowing me to borrow it.

A Bit of a Yo-Yo: Not Quite Bipolar, But Not 100% on an Even Keel, Either

I admit to being one of the more yo-yo-like individuals on the planet who does not have an actual bipolar diagnosis. Life in general for me, as well as my overall outlook,  is much more cheerful and convivial than it was just a few days ago. My precious puppy is still dead, and there's no way I can put a happy face on that aspect of my life or on the puppy's very short life, but other things in my life are settling into place.

A person who was recently very inappropriately unkind to me has received her comeuppance. Perhaps I shouldn't be so overjoyed about this having happened, but in general, Karma is something that makes me happy. I don't all that often do things to cause myself to be on the down side of Karma, though I am human and can on occasion allow my emotions to get the better of me to the extent that I wish ill on a person when it would be better for everyone involved were I to clear my mind and allow the universe to unfold as it should without mirth on my part at a difficulty experienced by someone else even if I view the difficulty I experienced  as a direct result of the person having been deliberately vicious to me. For the most part, I am one of the people in the world who doesn't have to eke out an existence in a war-torn nation or in an area devoid of a potable water supply.  I am fortunate and blessed, and I try not to forget it. I have no idea why it worked out that way for me. I should simply count my own blessings and not worry about when God or Karma or anything or anyone else will get even with someone who has been cruel to me beyond the scope of his or her duties. Sometimes it's someone's job to tell me that I have erred. I can accept that even when I'm made aware of the error of my ways in a not especially diplomatic matter. It's when I'm wrongly castigated, especially by a person who has no authority to do so, and even more so when the person seems to make it a point to be as public as possible in "reprimanding" me (I used the quotations around reprimand because my understanding of the word is that it only truly applies when the person who issues the reprimand is in some way acting with appropriate authority) that I take exception to the  act.  By the same token, I've heard my peers refer to having been "called on the carpet" or "written up"  by someone with less authority than they in regard to the matter over which one has been criticized. A person without any authority whatsoever  can make a complaint about a person to another person who possesses authority to address the matter, but the original complainant cannot "call the person on the carpet," so to speak, nor "write the person up," if his or her rank is lower than that of the person he or she purports to "call on the carpet" or to "write up."

Suffice it to say that in my recent case of having been publicly [temporarily] humiliated by a person who operated under the mistaken assumption that she was in a position of authority to reprimand me, even though she truly believed that she held sufficient authority to correct my actions, my demeanor, my apparel, my hair and make up, and other things, she committed a few key errors along the way.  First and foremost, when in doubt, a person would, more often than not, do well to choose a the kindest choice of action when given the option. In my particular case, the kindest choice of action would have been to have spoken to me privately instead of seeming to intentionally amass the largest audience she could practically gather on such short notice. (Not only would this have been kinder with regard to me; she would have been kinder to herself. She would have endured far less humiliation had she privately singled me out for obliquy. Her superiors might not have noticed that she was acting so far out of line, and might not have taken her on in the manner in which they chose to do, and she might thus spared some degree of public humiliation had the audience [which she went out of her way to solicit] not been present in such force , hence sparing her such a public dressing-down.

Neither do I overlook the audience's role in all of this. A few just stumbled into the situation and had no idea what they were in for; I think I know which ones they were, and I place no blame on them. For the most part, they were no friendlier with her than with me prior to the incident; they were looking for entertainment. They're all far too old and should be much too professional to have been caught up in this matter. They're not much less blameless than if they were there in anticipation of the two of us engaging in a knock-down, drag-out, hair-pulling fight, which was never going to happen regardless because I can run a hell of a lot faster than the other person can even when I am weakened by an especially draining case of colitis. I hold the intentional audience accountable for their role. While I haven't made a formal list of their names, I remember who they were. If I have a chance to do a favor for any one of them, I most likely will not. Secondly, my castigator would have been wise to have spoken her words in the most diplomatic way she could have  managed. Diplomacy comes more easily to some than it does to others, but anyone, in any given situation, has the option of choosing kind words, or at the very least, professional words, or choosing words that will make their impact in the most wounding way possible. She chose the second option.

Attending physicians sometimes choose this course of action with the rationale that eventually, someone's life will be on the line, and by making a stinging point to a future attending physician, perhaps the point will stick with that future doctor in such a way that he will remember the lesson learned more fully and that the future physician will perhaps be less likely to commit an error that may result in loss of life. (Perhaps my nemesis might have suffered a temporary delusion of grandeur and might possibly have mistaken herself for an attending physician.) I'm actually giving the attending physician and the creep the benefit of the doubt in saying such. In some cases, the attending physician is simply being unkind because he can be; he possesses the authority to verbally abuse others to some degree , and he intends to use it because he can. Perhaps he had an argument with his wife or child earlier that morning and is taking out his resulting anger on an intern or medical school student, or perhaps someone took his designated parking space, which is another offense for which someone had to pay even if it was not the person who had anything to do with the attending physician's parking space having been misappropriated. Perhaps the attending physician  truly is a jerk. Or perhaps he genuinely feels that a medical error is not being taken sufficiently seriously and is responding in a way that to the rest of us seems unduly harsh, but, in the more experienced judgment of the attending physician, is necessary in order to create the sort of impression that would cause the underling to remember the incident and to take it with sufficient gravity that it doesn't happen again unnecessarily.  In  my humble and inexperienced opinion, the cases where the latter is true -- those cases in which an attending physician truly he believes he is potentially saving future lives by ensuring that the medical student or intern grasps the ponderousness of the situation as the result of the attending physician behaving as an asshole --  are the minority. It's my opinion that in most of such cases, attending physicians who behave like jerks do so simply because they are jerks -- some take extreme delight in causing female physicians-in-training to cry --  but I don't profess to know which is the case in every situation, and certainly there are times for righteous indignation. (And I'm getting a lot better at staring down abusive attending physicians without crying.) In the grand scheme of things, other than the initial harassment case, I've suffered less abuse in grand rounds than have most of my peers, but we've all come under fire to some degree. While I understand the need for righteous indignation on occasion (it's one of my least favorite word combinations from the Holy Bible), I believe that it's overused in the field of medicine and only rarely serves to make anyone a better health practitioner than he or she would have been without it. 

Nonetheless, before anyone goes so far as to express righteous indignation, especially in a decidedly public manner, one would do well to ensure that he or she possesses the jurisdiction to perpetrate the reproof in the first place.  Anyone can civilly take up with a colleague, especially in a quiet manner, a disagreement as to how any situation was handled. If such is done in a sufficiently diplomatic manner, usually a third party isn't even required for mediation unless there's a technical matter on which two people cannot agree and it's of sufficient importance that not clarifying which side is correct could potentially result in harm to a patient.

Not just anyone, however, can arbitrarily conclude that because it took her longer to satisfactorily complete the same number of rotations (or, technically, fewer rotations) than it took another person, that the person somehow possesses seniority and authority over the other person.  Protocol exists to the contrary. Regardless, it is not the place of a fifth-year medical student (who is in her fifth year of medical school because she required five years to complete what many medical students can complete in four years) to point out another's personal failings, most of which had nothing to do with the study of medicine, to someone she considers to be her inferior.  I listened to her criticisms without comment, and would have continued to do so regardless of the circumstances. Fortunately in this particular case, enough superiors were present who chose to intervene on my behalf and set the person straight as to the necessity for her to focus on her own studies and not upon my hair, fingernails, cosmetics, shoes, the fit of my scrubs, my frequent visits to the bathroom because of a colitis flare-up, and my occasional inability to make it through surgeries all the way to completion because of colitis.   I'm not likely to hear her criticisms again, which is, for me, a feeling  both of vindication and of empowerment.

I have only two remaining days to work before I prepare for a lengthy vacation. It will be to a cold weather location, though I don't intend to take in lot of winter sports. I may ski or snowboard a bit, though not much. Instead, I'll watch the Winter Olympics figure skating on TV in one of the rooms of my hotel suite. I'll order from the hotel's 24-hour-a-day room service menu.  I'll play the grand piano that is in my hotel suite whenever I feel like doing so. I'll do the same with my  violin. I'll do a bit of snowmobiling and will travel by horse-drawn sleigh to the restaurant that is only accessible by sleigh, horseback, or snowmobile. I'll sleep, read, and stare out the windows of my corner suite at the gorgeous views.  The vacation is the most decadent one of my life (I thought our Christmas trip to Austria last year was decadent, but it was practically slumming it in comparison to this one.  I recognize that, at least this early in my career, it would not be prudent for me to spend money on vacations of this level on anything resembling a regular basis. Because of the way this vacation came about, which was a result of a cancellation of a concert by a performing artist,  a bodyguard is even a part of this package deal. The very idea of my needing a bodyguard is preposterous, but I sometimes hear scary noises at night.  I'll sleep with a bit more ease with the knowledge that the bodyguard comes as part of the package deal. I'll need to give the bodyguard a substantial tip, but because this trip is a once-in-a-decade thing at the most, I can afford to do so.

My feared fracture with a friend was a false alarm. False alarms seem to be plaguing me at an alarming rate, or at least with an alarming degree of severity.  First it was the cell phone notification of the threat of the ballistic missile while I was in Hawaii, which was a bit disturbing.  Next it was the implied threat of  a break-off of a friendship due to purely unintentionally hurtful words followed by unintentional silence. In all honesty, the threat of the loss of a friendship was more traumatic to me than was the ballistic missile threat if for no reason other than that I never took the ballistic missile threat entirely seriously. 

Regarding the threat of a loss of a friendship, due to things that happened  in my distant past that I've never discussed here out of protection for the reputation of my mother, but may at some point write about, I take close friendships or relationships of any sort very seriously, and the threat of the loss of one is most discomforting to me. Yet not every perceived slight is intended as such. Sometimes people are simply very busy. We all have work that must be done. Neither are communications always meant exactly as they are taken, which is an inherent characteristic of communication by text.  While I still think at least one thing my friend said was unnecessarily harsh, there was no intent on his part to hurt my feelings. Sometimes one has to take things at face value and not read more into something than was intended. Also, friends will disagree on occasion. If the person is a real friend, it's something one can move beyond. This person is a real friend, and so we can move beyond such things as miscommunications and misunderstandings. Life is too fleeting to allow oneself to be excessively caught up in the minutiae of every misunderstanding. It's better to apologize, to learn from the experience, and to get past it.  Real  friends are too few and far between for one not to forgive and forget when trivial misunderstandings are involved.

This video belongs to someone other than I. To whomever is the rightful owner, I express my appreciation to you for allowing me to borrow it.

Very Sad News

I can keep this in perspective. I fully comprehend that today alone, perfectly healthy people were killed in freak accidents, newly married spouses were separated by the death of one or the other in auto accidents, and children died of cancer. I know this not from having read the more morbid sections of today's news briefs, but because it's the sort of thing that happens every single day. Why should today be any different?

Tonight our family lost the new puppy my parents picked up on Christmas Eve and I met on Christmas morning.  I believe the acquisition of the puppy was intended to in some way soften the blow of a boyfriend having recently broken up with me. So much for that. Parvo was the culprit in this case. Veterinary medical science did what it could to save the puppy, but in the end it wasn't enough. Rest in peace, Father Guido Sarducci II.

I don't think I want to have any more dogs.

Traveling, Super Bowl Heroes, and Other Matters of Trivia

Bill Belichick, my hero

I've been on contact with a travel agent and am in the process of scheduling a vacation. It will be a ludicrously extravagant and expensive vacation, especially since it involves a cold-weather location  and I have limited plans at best to take advantage of winter sports. My parents would positively freak if they knew I intended to spend even half the money I intend to spend in order to finance the trip. I  fucking don't care.

The check from my broker should be in my hands shortly unless my broker wishes to hear from my attorney (I still have access to one attorney who speaks to me), but that doesn't really matter, as I have lots of access to this wonderful thing known as a credit card.  I actually own two of them. I've never used either. Don't worry about me. I understand the importance of paying off the balance monthly.  I've been told by my financial  advisor that I'm better off using credit cards than using ATM cards for the most part because credit cards offer greater protection in the event of fraud. I've mostly dealt with the issue by carrying cash, but that's really not such a smart idea, either. Nearly all medical students have access to credit. The further one goes toward completion  of medical school, the more abundant one's access to credit becomes, as the agencies who finance the credit have a much greater chance of actually recovering any money they loan out to a medical student if the student is nearing completion of medical school.

I've been fortunate. I worked in high school at what would be considered a high-paying job for a high school kid who is not an a-list entertainer.  As an accompanist for the various high school vocal ensembles, I was well-compensated. My mother -- probably more out of a sense of loyalty to musicians in general and out of respect for the inborn talent, tutelage, and time it takes to develop the skill level necessary to accompany a group of singers in public competently enough that one never detracts from the singers' performances -- negotiated a sweetheart deal for me. I probably shouldn't say too much about what my hourly wage was, but it was comparable to teachers' rate of overtime pay in our particular district. Teachers' base pay in any given district is based on the number of years they have taught for a district and the level of education they have attained. Their rate of pay for putting in extra time beyond what is contractually required but is still mandated or all but mandated by their districts doesn't typically match the prorated hourly rate of pay they receive for the work done during a regular teaching day. A whole lot of the work teachers do is not done on the clock, and, as such,  is not in any way compensated, but if districts require teachers to attend extra inservices and other meetings outside of a regular workday, districts are usually -- depending upon the master contract agreed upon by the teachers and the governing board -- required to compensate the teachers for their time.  Depending upon the district, this rate of compensation for overtime is typically either the hourly pro-rated salary of a very beginning teacher on the very lowest rung of a district's salary scale or, occasionally,  the hourly prorated mean salary of teachers in the district. A few civilized districts actually compensate each  teacher for overtime at his or her regular contractual salary rate, but such districts are few and far between. In any event, the rate of pay I received for playing piano for the vocal ensembles was only pennies less than what teachers were paid for overtime.  My mom's
rationale was that I could easily walk away from the job, and she wished the district's music department all the luck in the world in finding a pianist skilled enough to do the job consistently well. Even with a university in our community, the odds were against the district locating a musician of my caliber for the amount of money they would have liked to have paid.  University musicians, for one thing, are as often as not notoriously flaky. Did the music department really want to risk having an accompanist no-show an important performance?  Furthermore, university musicians, if they're good, also know their worth. They weren't likely to accept any position that paid maybe a dollar above minimum wage.  So my mom met with both administration and the music department head to explain the reasons why whatever accompanist was hired -- me or someone else -- needed to be paid at a competitive rate.  Piano lessons received throughout one's musical education were not free, nor were the technique books, nor was the instrument needed at home to practice. Furthermore, acquiring the skill of playing piano proficiently requires much practice. Just as educated professionals expect to be paid at a rate commensurate with their level of education, musicians deserve to be paid at a level that takes into account the countless hours of practice that were necessary to acquire a level of skill that would allow a person to serve as a piano accompanist.

The district superintendent suggested that I serve as an accompanist for the privilege of receiving class credit for any period I accompanied, in addition to the idea that I should be serving as an accompanist in the name of school spirit. My mother suggested that the superintendent tear up his monthly five-figure paycheck and work for free in the name of school spirit as well. Predictably, he rejected the idea. I got the salary my mom demanded for me.

In addition to the school job, I earned almost an equal amount by playing piano or organ or occasionally violin for weddings, funerals, church services, and other functions. My parents required that I contribute ten per cent of my total earnings to the charity or charities of my choosing. I was allowed immediate access to ten per cent of the earnings (in which I barely made a dent; I just went through the last of that ten per cent about a month ago.) The remaining eighty per cent was banked in some sort of account that would give me the maximum interest for an investment with very low risk. I didn't work that hard to have all the money disappear in a market bust.

I now have access to that money.  I earned enough scholarships to pay for undergraduate education and medical school. Additionally, their are moderately large grants associated with most University of California campuses based on one's competitive standing at graduation. My standing was sufficient to give me access to a grant in the high five-figure range. That one came totally out of the blue. I had no idea that such grants existed.  Furthermore, and I don't talk about this much even though there is no confidentiality clause in the final settlement, when I was assaulted in my final year of high school, I received settlements from the school district as well as from those who attacked me.  The settlements are structured to some degree -- I couldn't withdraw the entire amount right now --  but I could have used anything I needed for educational expenses, and I can withdraw a minimal amount now for living expenses as well.  I'm considering this trip a living expense.  The bottom line, though, is that, while I don't want to boast because it's really not something about which to boast, I hold significantly more assets than my average cohort mate holds in debts.  I can afford a luxurious trip.

 I am appeasing my parents (who don't even know about this trip yet unless they're reading this blog)by staying within the borders of the U.S. Traveling to Canada would probably also be fine in terms of the integrity  of the blood supply should it become an issue in the event that I were to  require a transfusion, but I  have a sneaking suspicion that I will see as much of the Great White North as anyone would ever desire to see in the next few years.  I'll stay south of the northern border for this trip.

Some people say Florida is lovely this time of year, but I have no desire whatsoever to go anywhere near there.  With my luck, I would get sucked into one of their giant sink holes. Furthermore, there are those with whom I am acquainted (??? Is a fan truly acquainted) who might possibly accuse me of stalking were I to travel to Florida. Since I have no desire to go there anyway, it's an easy call for me to make. The Sunshine State will get by just fine without my tourist dollars. My preceptor's husband wants me to go to east Tennessee. I rank his suggestion right up there with the possibility of traveling to Florida.

Have a nice weekend. Enjoy the Super Bowl if such is your thing. I won't, as I will be working. Someone can tell me about it later. I would record it if I cared that much, but for some reason, it seems anticlimactic to watch a recorded version of the Super Bowl.  I don't have any strong stake in who wins.  I dislike Tom Brady. I should dislike Bill Belichick  because of his tendency to play fast and loose with the rules, but something about the mind games he plays with coaches and members of other teams appeals to me. I have genuine appreciation for the idea that other teams bring their own Gatorade to Patriots' home games because they're so paranoid of what Belichick might do.  I don't know if the other teams' personnel just think he'll serve the Gatorade to them too warm or if they actually think he'll have the stuff laced with a harmful substance. And that's just the tip of the iceberg.  He has everyone else in the league mind-fucked beyond belief.  It's a skill I envy and admire.  I want to be Bill Belichick when I grow up.

I could travel here . . .

or here . . .

or here . . .

Even within the continental U.S., the possibilities are virtually endless.

A Very Old Story About a Strange Childhood Friend

I once said in this blog that I had never had an actual friendship that went totally bust. what I said wasn't entirely true. I probably thought I was being truthful when I wrote it, but one former friendship I tended to block from my consciousness. That was the friendship that didn't end well.

Karenna and I were friends and neighbors the year I was in fourth grade. I would have turned nine in December of that year.  Karenna was a tall, solidly built Dutch-American girl. I believe all four of her grandparents were born either in the Netherlands or in some territory the Netherlands controlled. Most of the family was somehow connected to the dairy industry, but Karenna's mom was an operating room technician, and her father was a math professor at the local university. Their Dutchness pervaded practically every aspect of their existence. In retrospect, I'm surprised they didn't all wear wooden shoes.

In actuality, they were not merely Dutch, but Frisian.  Those originally inhabiting the Frisian regions, located in coastal Netherlands and a portion of Germany, are ethnically similar to Anglo-Saxons. Their language bears resemblance to the original Anglo-Saxon language as well.  At this point, however, most of them who live in the U.S. claim Dutch as their ancestry. With intermarriage happening as it usually does, most Frisians actually are part ethnically Dutch.  While they don't typically dress in traditional Dutch or Frisian costumes in the U.S. (they probably don't in Frieseland anymore, either) they retain customs including the food they often eat (that Mrs. Zwaagstra was continually trying to force-feed me because I was so short and scrawny compared to her own hulking brood) and the religion they practice. 

The Frisians, as do many Dutch, practice religion in some form of what is now called "The Reformed Church.' Back in the day, it was "The Dutch Reformed Church." It's now roughly fifty bazillion separate denominations, with the largest here probably being The Reformed Church in America. They're considered mainline Protestant, but they're pretty far to the right as mainliners go. What is mildly interesting is that most nations had their own reformers they followed. The Dutch who practiced reformed religion tended to follow the works and writings of John Calvin, who is primarily considered a Scottish reformer. All of that, however, is neither here nor there.

Karenna and her family, the Zwaagstras, attended a Reformed Church. There wasn't one in our city, so they drove about an hour each way to attend the church of their choice. Their church had morning and evening services.Once in a great while, they made the trek home after morning service, then headed back for another one-way hour-long drive to their church's evening worship service. Most of the time, however, they killed time in the town where the church was located. Sometimes they were invited for afternoon dinners at the homes of fellow parishioners. Sometimes they packed picnic lunches. Sometimes the weather was so lousy that they hung out in their car from the end of morning worship service until the 6:30 start time of evening worship service.  While attending Sunday mass was far from the highlight of my week, I was quite content to be, in a religious sense, a Rousseau and not a Zwaagstra.

The Zwaagstras had four children. Karenna was the third eldest of the four.  Any one of the Zwaagstra offspring would have gladly gouged the heart out of any one of  his or her siblings with a letter opener over something so inconsequential as the order form for a toy on the back of a cereal box; it wouldn't even have needed to be an actual toy in the cereal box.  The LDS church has a hymn (other churches may use it as well, but it's most commonly associated with Mormons), the first line of which is "There is beauty all around when there's love at home."

If the hymn hadn't predated the modern Zwaagstra family my roughly  one hundred years, I would say that the person who came up with those lyrics did so by watching the Zwaagstra family in action and writing down the exact opposite of hat he or she saw in poetic form.

At first, the Zwaagstra family lived across town from us.  One parent or another (probably my mom; Mrs. Zwaagstra was always working, and who could possibly blame her?) arranged a playdate for us. My mom arranged to be off work earlier than usual in order to pick us up from school and to supervise our play. At some point, Karenna made some comment to the effect of. "Your house ain't got no class. You ain't even got no nice living room furniture."  (The Zwaagstras had a living room full of ugly but expensive floral overstuffed furniture; the offspring were forbidden from even entering the living room unless the family was entertaining company in the room, but anytime Dr. or Mrs Zwaagstra was away, the kids made themselves at home in the living room, eating Cheetos and drinking Kool-Aid, and having no-holds-barred-no-rules tag-team wrestling matches.) My mom was willing to ignore the insult to her home décor; in truth, my parents didn't spend much money on home furnishings except for the sixty-thousand-dollar (in 1990 dollars) piano we had in our living room. They were saving for their next house, which they planned to purchase in about a year and to furnish at least somewhat respectably. 

My mom did take exception to the manner in which Karenna delivered her message. As the child of educated parents, my mom felt that Karenna should have known better than to verbalize her sentiments in the manner in which she did.  While my mom ignored the rudeness of Karenna's criticism of our home furnishings, she chose not to ignore Karenna's deliberately poor syntax, though she spoke to her far more gently than she would have either to my brother or to me had we said the same thing. "Karenna, we don't use the word ain't in this house.  You could have said, "Your house has no class. You don't even have nice living room furniture."

I think I've shared Karenna's response to this once before in another context.  Karenna's  answer to my mother was, "Lady, it ain't none of your damn business how I talk English."

"We don't speak to one another in that way in this house, " my mom replied to Karenna.  

"No one's forcing you to speak to me, " Karenna answered my mom.

My mom's response was to grab her purse and car keys and to drive Karenna home. I think her intent had been to speak to Mrs. Zwaagstra, but she, of course, was nowhere to be found. What my mom did find, though, was Karenna's older and younger brother using a rope to trustle their cocker spaniel, which they then hoisted above the ground and tied him, leaving him suspended by rope from the tree.  My mom was horrified, as was a neighbor who happened to walk from his house  into his driveway and observe the act of animal cruelty. The man and my mom were able to free the cocker spaniel without any noticeable injury. 

"We weren't hurtin' nobody or nothin;," Karenna's older brother Brad protested. "We was just givin' him a little ride." Neither the neighbor nor my mom bought the story. The neighbor took the dog with him and said he would keep it in his possession at least until he could explain to the parents what their sons had done, and possibly longer.  I have no idea if the dog was ever returned to the Zwaagstra family. I hope not.

My mom told me on the ride home, her hands shaking for some reason as she held the steering wheel, that she didn't consider Karenna to be a suitable playmate for me.   From that point, we still hung out at school. Parents back then didn't do much to control whom their children associated with at school.  Then the house directly across the street from us went up for sale. As luck would have it,   the home was purchased by Dr. and Mrs. Zwaagstra. 

It's one thing to tell your kid she cannot have play dates with another child when the child's home is two miles away from one's own home. It's another matter entirely to tell  one's child she cannot play with a little girl roughly the same age who lives across the street and who does not yet have a police record.

Karenna and I resumed playing together when school was not in session. Sometimes we did homework together, which usually consisted of Karenna copying the answers to my homework. Even at the age of nine, I understood on some level that I was being used, but I didn't care all that much. I nearly always had fun when I was with Karenna. We climbed on people's roofs without being caught.  We collected cans, redeemed them, and used the proceeds to buy candy. We occasionally collected ketchup, hot sauce,  and mustard packets, then put them under the tires of cars in the driveways of families of whom we were not especially fond so that a mess would be made in the driveways when the cars were put into reverse. We committed little significant harm, but had a great deal of fun.

Karenna cheated blatantly at board games; her entire family did. The object to board games, as far as the Zwaagstras were concerned, was to cheat and not be caught. I tolerated her cheating to a point, then eventually called her on it and said I would quit the game if she didn't play by the rules. She typically capitulated. 

Karenna had a bit of a fascination with matches.  I knew that playing with anything that caused fire was absolutely forbidden. Karenna eventually learned that I would leave if she brought out the matches.

At that point in my life, I was still enrolled in gymnastics, and was at the gym as much as I was home. This was probably to my advantage. I got into enough trouble with Karenna in the eight or so hours a week I was allowed to spend with her outside of school time. Had we been together every day after school until dinner time, (my mom drew the line at allowing Karenna to sleep over at my home or allowing me to sleep at her house), we might have put a skunk into someone's house or gotten ourselves stuck in someone's chimney. 

On one particular rainy day, we played hopscotch in Karenna's garage with the door open. We could see the city's sanitation truck approaching.  Johnson, the man who operated our city's sanitation truck was a kindly African-American fellow who, to the best of my knowledge, never harmed or spoke an unkind word to anyone in his entire life. I believe "Johnson" was his actual first name and Pierce was his surname. I'm not sure why the children of a city were encouraged to call this adult male by his first name, but as far as I know, that's what all the children called him.. As the garbage truck got closer, Karenna proposed, "Let's yell 'N-----!" at Johnson!"

"I'm not allowed to say that word," I told Karenna.

"You chicken!" Karenna practically spat at me.

"Yes, I am a chicken," I agreed with Karenna. "I'll get in super huge trouble if my parents find out I said that."  I should not have needed to use my parents as my excuse. The wrong of it alone should have been a sufficient deterrent.

As the garbage truck approached, Karenna warned me, "You're in or you're out.!"  I knew that I had little choice but to opt out.  I headed out of the garage, walking into the rain and not even bothering to try to hurry in order not to get wet. I had reached the point of the driveway where it slopes to the level of the street when Johnson drove the sanitation truck directly in front of the Zwaagstra's house, waving at the two of us with one arm as he moved the lever lifting the trash receptacle to empty itself into the large bin in the back of the truck

"N-----! N-----!" Karenna hollered in he loudest and screechiest voice at Johnson. I looked at Johnson. His face wore an expression of both puzzlement and pain. I shrugged, then walked across the street and into my own house. I said nothing to my mother, which was a mistake and which might have cleared things up slightly more expeditiously, but the damage had been done.

Later that evening, after Johnson's sanitation route had long been finished and after most families in our town had probably finished dinner, Johnson drove

his pick-up truck to the Zwaagstra home. As there was no school the next day and homework had been completed, I was allowed to watch television. I didn't recognize the pickup truck as it parked in front of the Zwaagstra home, but  once Johnson exited the truck, there was no question as to what was going down. I ran to my upstairs bedroom, not bothering to watch as Johnson approached the Zwaagstras' front door and rang the bell.

A few moments later, I heard the sound of our own doorbell. I heard adults talking, and then I heard my own name being called.  Despite knowing I hadn't been an actual party to the racial and verbal abuse that took place earlier in the day, still I was terrified.  I reached my living room to find my own parents, Mr. and Mrs. Zwaagstra, Johnson, and Karenna, who had tears running down her cheeks.

"It seems that some extremely unfriendly and inappropriate words were spoken to Mr. Pierce [that was the first time I had ever heard him referred to as 'Mr. Pierce'] earlier today. What do you know about this, Alexis?" my father asked me.

I swallowed hard as my father and the others waited for my answer. "It happened." was my laconic reply.

"Would you care to elaborate? Who said what to whom?" my father pressed.

I swallowed again, knowing that an untruthful answer would get me into more trouble than I had ever been in my entire life, but that the truthful answer would cost me a best friend. "Karenna said, "N-----! N-----!" I answer. 

"You filthy liar!" Karenna roared.

My mom spoke. "I think we've gotten to the bottom of this. Dr. and Mrs. Zwaagstra, Karenna?"  She opened the door and held itopen, inviting them to leave. 

My parents apologized profusely to Mr. Pierce.

"It wasn't your little one that said it,"  he countered.

"You shouldn't be hearing that from anyone," my dad insisted. My mom poured coffee and cut slices of cake as the three of them sat at our family's dining room table.

I was sent back upstairs to complete my homework, which had been completed hours earlier, though I knew better than to argue the point. I was still in the dark as far as what had been said out of my presence.

Later, after Mr. Pierce left, my parents came up to my room. They explained that when Mr. Pierce told Mr. and Mrs. Zwaagstra what Karenna had said, she first blamed me solely, and then insisted that I had shouted it along with her.  Mr. Pierce had seen that I was nowhere near Karenna when the ugly words had been hollered.  Mt. and Mrs. Zwaagstra had  chosen to believe their daughter. My parents believed Mr. Pierce. I assume they would also have believed him had he said I had been the one who spoke the venomous words.

My mother didn't tell me I couldn't play with Karenna anymore. By the time school started the next day, Karenna had already assembled a gaggle of girls who would snub me for a large part of the remainder of the year.  Karenna herself ignored me, which was just as well, as she possessed enough of a size advantage over me that she could have injured me had she chose the physical route to her from of justice.

At one point I told Karenna that I was willing to forgive if she was. She answered that I had nothing for which to forgive her, and that she had no intention whatsoever of forgiving me. Still I help out hope. Every time the telephone rang, I prayed it was Karenna. (I lost a bit of faith in the power of prayer through that experience.) Whenever I looked out the front window and saw Karenna emerge from either her front door or garage door,  I hoped that it would be to my house that she was headed.  Reality eventually became inevitable to me. Karenna was not going to call or visit. Still, I remember the almost physical pain of looking at the phone, willing it to ring and willing Karenna to be on the other end of the line.

We moved about ten weeks later, thus making it easier to forget Karenna and to move on. I wonder if Karenna grew up to be a sociopath, or, for that matter, if she even grew up. It's not beyond possibility that she and her three siblings killed each other in a massive brawl.

At any age, it's hard to part with a friend. It's hard not to look at a cell phone every five minutes to see if there just happens to be a text.  Reality will set in eventually. It just hasn't yet.

                I don't own this video. Thanks to the person who owns it.

It's Time for Me to Get Out of this Place

I do not own this video. I express me appreciation to its rightful owner for allowing me to post it.




I had eagerly anticipated completing my pediatric surgery subinternship. It has since turned into something of a nightmare. I make it through roughly half of the surgical procedures to which I'm assigned without having to excuse myself and bolt for the bathroom. My supervising physician is being kind, or at least patient; he knows I don't want this to happen any more than he wants it to happen.


I'm working this weekend and early next week. Once Wednesday's shift is finished, I'm off for a lengthy break. I've mentioned earlier that multiple trips have been thwarted. I probably should go somewhere, but the weather in the U.S. isn't at its mildest, and my parents think I shouldn't leave the U.S. with my present health situation. It would be a bad idea to expose myself to a compromised blood supply in the not-all-that-unlikely event that I might require a transfusion.

I'm considering ignoring all common sense and going to a place where the weather is frigidly cold. I don't necessarily have to leave my hotel room once I reach it. I could find a hotel that guaranteed a nice view, then order room service for the next few week as I looked out the window and watched the snow gently making its way to the ground.  I need to find a hotel that owns a piano and grants access to it to guests who are skilled pianists.

the view I want to see from my hotel room window

Friends and Fans, and How to Tell the Difference

I'm surviving but barely.  Work is a chore with which I would prefer not to be bothered. None of my superiors have complained yet. I try to smile at everyone and act as though all is peachy. I don't know if anyone is buying my act other than the children. They're just dumb little kids. They don't know if anything is wrong with me personally, nor do they give a rat's ass. For that matter, no one else gives a rat's ass, either. My mother keeps saying, "I told you nothing good would come of this."

As a word of caution, fans are fans. Friends are friends. The two terms are not interchangeable. It's possibly OK to occasionally flatter a fan by calling or referring to that person as a friend, but the reverse is not quite so acceptable. It's almost like calling one girlfriend by another girlfriend's name when you're maintaining dual relationships on the sly. That, too, has happened to me, so I know how that feels as well.

If a fan is a fan. Let it be. There are worse things in the world to be than fans. Bitches, hos, cunts, and a few other terms come to mind. Don't tell the person that she is your friend, and then call her a fan. It will hurt her feelings.

I don't do Facebook, so I am less affected by this, but at the same time, even if your fan/friend isn't on Facebook, don't lie about who is or isn't among your Facebook friends.  You don't really have to say anything at all about it. It's your business.It's your personal prerogative to have anyone you choose as a friend on your Facebook page even if you maintain separate public pages for fans and private pages for family and what you consider "old" friends. You owe no one any explanation. If, however, you go out on a limb and volunteer an explanation, and it ends up that at least part of what you said was a lie, it reflects poorly on your own character as well as hurts the feelings of the person to whom you lied. The person to whom you lied feels either that you considered her to be so incredibly stupid that you could say virtually anything to her and she would believe it or she is once again reminded that you lied to her when you told her she was your friend when, in actuality, she was nothing more than another fan.

Why you wasted any of your precious time on the person who was once a friend or fan is a mystery for the ages.

I don't own this video. Thanks to he or she who owns it for allowing me to leave it here for however long it is here.

All Dressed Up and Nowhere to Go

one place I will not be traveling soon

The fourth and final (for most of us, that is) year of medical school has breaks built into it both for board exam study and for traveling the country both for the purposes of interviewing for residency positions and so that we all might actually see and experience these places at which we interview. We legally obligate ourselves to spend a bare minimum of a year at any location with which we secure a match; it's more likely three to five years. In extreme situations, physicians in training will spend eight years in the location of their residencies. It only makes sense that a person spend just a bit of time at the place before potentially agreeing to devote multiple years of his or her life to studying medicine there..

The process is both time-consuming and expensive, though it can be viewed as a way to see the U.S. in a way one may never have seen it before.  I traveled as a child and youth with my family, so I've had at least some exposure to most regions of the  U.S. Some members of my cohort, though, have traveled no further from California than to the neighboring state of Nevada if that far. Some of the foreign students have seen, other than California, only what you can see of a state from its airport or by flying over it at an altitude so high that sometimes one's only view is cloud cover.  It adds to overall student debt for most of those in medical school to have to borrow additional funds in order to pay for plane tickets and hotel rooms, but it is, for the most part, money well spent. Furthermore, because it doesn't happen until one's final year of medical school, one has a reasonable assurance of completing medical school and eventually earning the money to pay back both the travel debts and the other debts incurred in attending medical school.

Some of our nation's more "innovative" programs attempt to circumvent this process by holding skype or face time interviews.  I can see the financial advantages to conducting interviews electronically, but there's really no viable substitute for actually traveling to a place. We still see only the tiniest sampling of the place. We're told to make it a point to go somewhere besides from the airport to the hotel to the hospital and back again, but the view still is one-dimensional. A candidate sees the place in only one season and is exposed to a mere sampling of the local population. Still, it's the best we can do at this point, and it's better than the best cyber-tour.

I've completed my visits and interviews and am preparing my lists (both U.S. and Canadian) for submission to the national registry. After that, it's simply a matter of waiting until March to learn whether or not one's lists matches up with the list each teaching institution submits with names of desired candidates.  At our institution, students know earlier in the week whether or not they have received a match. (If they haven't, they can still scramble for positions, and in some cases end up with the preferred positions. All is not lost for them.)  Match Day is the biggest celebration -- more so than graduation -- for medical school students. Much drunken revelry takes place, and students typically take off at least one day following the ceremony.

I will have a block of time during which I will have no duties beginning in less than two weeks. The original plan was for me to travel with a group of cohort mates to New Guinea. That trip fell through. Plan B was for me to travel to New Zealand as part of a group trip with medical students from around the U.S. that offered ample individual time in addition to the group activities. That, too, fell through today. My financial advisor had been advised two weeks ago that at least one of my assets needed to be sold in order to finance the trip, and that I needed the check in my hands by yesterday at the very latest. Today would have sufficed as well; it seems now that I was right about the artificial deadline being necessary. I should have told the moron the check had to be in my hands two weeks ago.  I showed up at his office bright and early at 6:00 a.m. (financial officers tend to work east coast hours here because they're impacted by the opening and closing of the stock market). I might then have had a prayer of having the funds available  today. I called the company sponsoring the trip and offered them every credit card number I have, my first-born child, and possibly even sex if they would take some form of currency other than cash. The answer was no.

So instead of luxuriating in New Zealand, I will spend the time I have off in the hole that I will dig for myself in the backyard of my condo. It will be swell, I'm sure.

another place I'm unlikely to see in the immediate future

SOMEONE PLEASE TELL ME THIS GETS EASIER

I'm not sure anyone ever suggested that life in general is supposed to be easy. I'm certainly not finding it to be that way. Some people allude to the placidity and to the carefree nature of childhood. I'm not sure that even childhood was an especially happy-go-lucky era in my life. If memory serves me correctly, most of my childhood was spent walking around on metaphorical eggshells, trying not to make anyone angry and trying not to get into any trouble. Undoubtedly the times of stress were interspersed with good times, but it just seems like, for as far back as I can recall, my raison d'etre was to keep someone from finding out about something, to smooth over someone's ruffled feathers, or to make amends for some real or perceived slight I had committed. It would be easier for me to rationalize this away if I had good reason to believe that I was somehow more the exception than the the rule in this regard, and that most children devoted large portions of their childhoods, at least allegorically, sniffing or plucking wildflowers from fields and meadows.

I'm not blaming this on my parents, either. While we've had our moments as a family, as I would assume all families have had, I had caring and nurturing parents. If my relationship with one parent or the other was tense, it was probably because the parent was doing his or her job as opposed to either of them acting in a way that was either overly guilt-producing or punitive. Things at home were, for the most part, tranquil when we as a family were not dealing with something along the lines of a family member's life-threatening illness. Little of my childhood angst was connected to my parents. More often, it was peers or teachers, coaches, music teachers, extended family members, or other miscellaneous authority figures with whom I was continually struggling to navigate relationships and keep in harmony.

I'm finding young adulthood to be more of the same, as in the more things change, the more they seem to remain the same. I'm lucky enough to count among my friends a very small number of individuals who have never given me cause to distrust them or to question their loyalty.  Where time is concerned, though, I do not have the luxury of limiting myself to hanging out exclusively with my tried-and-true homies while pretending to myself that the rest of the world does not exist in a social sense. I must, unfortunately, interact with the rest of the world as well.

Socialization in today's world has grown to be unusually complex in that, in most of our circles, people exist with whom we rarely if ever have contact in the flesh, who, at the same time,  are very real parts of our worlds and of our lives. In the view of many people, this is symptomatic of many of the ills of today's society and is wrong in every sense. We need to be concerning ourselves with what is and who are concrete, real, and physically present in our lives. Emphasis upon and obsession over digital presence in our lives will, in the view of many, ultimately lead to the downfall of society as we have previously known it to be. or at least insist the naysayers.

Whether or not there is any substance to the degree or extent to which the virtual or cyber matters complicate our lives, digital presence and cyber-relationships are here to stay.  Whether they confound our existence to any greater degree than do more physically substantive relationships is a point over which nothing resembling consensus has at this point been reached, if ever it will be reached.  Regardless, I'm in the midst of what appears to be an at least moderately serious rift with a friend as defined under the parameters of cyber-friendship.  Following in very close proximity the fracture of my most recent and most serious romantic relationship to date, this schism has hit hard; to say that it hurts is an understatement.

I cannot share the details to the degree that I would like because friends (our relationship  presumably still falls under the technical category of friends and possibly always will) don't dish on one another just because a friendship isn't as close as it once was. I'm failing miserably at explaining what this is about in such a way as to allow my feelings to be at least cursorily  understood without saying more than I should say, and also to do so in such a manner as to avoid appearing to be the ultimate self-indulgent, self-pitying martyr.  Everyone has fallings out or at least driftings apart with friends. Why should I expect my own life to be sheltered beyond what is endured even among those whose existences would have to be considered charmed by almost any standards in the grand scheme of things?  (I read recently that if a person owns more than a single pair of shoes, he or she is in the top half of the world in terms of the cushiness of his or her lifestyle.  If there is indeed any validity to the link between a single change in footwear and privilege, I can claim no status other than one of extreme entitlement.)

My friend of whom I write is married. An unspoken or sometimes spoken parameter in friendships between members of the opposite sex when at least one is married is that marriage and family trumps all else, period. His matrimonial status hasn't introduced  any significant element of awkwardness in this relationship characterized largely by comfort, yet there was always a tacit understanding, at least on my part.   Any disquietude concerning any real or perceived lack of propriety in our friendship has been circumvented in the past to a great degree by a  considerable physical separation which was a reality of our relationship. It is possible for two or more people to have what is known as "phone sex," but that possibility in no way characterized the reality of our friendship.  Ours was a simple friendship. I'm feeling especially crushed in all of this because I  felt that I took extra care to show respect for my friend's status as a married man and to his marriage and family. 

The vast majority of communications between my friend and myself have taken place through text messages though we sometimes have held actual telephone conversations. My friend mentioned to me relatively recently that the two of us should speak, as in to hold an actual telephone conversation versus to communicate via text messages, concerning physical symptoms of ailments each of us suffer for which some of the symptoms of the two are in common.  I  noted a few times in the days immediately following in which I would possibly be available to talk by phone, then noted that I had no idea what my schedule would be like following that.

A text discussion concerning a third party -- a person considered to be erratic at best by those in the know concerning such matters -- ensued.  (In a matter that is really neither here nor there as absolutely no one other than the two of us would care about the details concerning this, we disagree concerning details related to the matter. I don't like to be one of such people who always HAS to be right because I find such people to be most obnoxious, but in this case, I AM correct and have proof. I erase my own  personal texts and those connected for the purpose of preserving the privacy of all, but a nurse texted with my friend using my phone. I never saw the text she sent until recently, much less
. . . . . . ....sort of relationship, you're not the only woman to whom it sounds as such. Keep in mind, please, that our friendship is NOT an "other woman" . . . . . ... relationship nor will it ever be, nor would I ever allow myself to be anyone's other woman. I'm giving my friend the benefit of the doubt in assuming that he , neither, has any desire for anything extracurricular by way of any sort of  extra-marital relationship, at least where I'm concerned. No man ever does. I'm simply not that attractive, and I am speaking from my rational self and not from any part of a martyr complex I may possess, nor am  I including this opinion so that others will comment "No, Alexis; it's NOT true! you really are pretty" and thus salvage my ego. It's merely that I'm not on any sort of equal footing in this friendship. I understand his need for discretion, as despite the benign nature of it all, perception can be everything where one's spouse and children are concerned.

Because my friend had earlier proposed a telephone conversation, I alluded to it in a text exchange.  Because he had only recently suggested a telephone conversation, I followed up regarding how that telephone conversation was supposed to work. His response was something to the effect of, "If I want to talk to you, I text you and ask if you have time to take the call. If your answer is yes, I call you." Period. Pardon me if I admit to feeling only the most of limited if any relational reciprocity whatsoever under this system. While, I get that he is the partner in our friendship who stands to have a spouse whose feelings could be hurt by random telephone calls, still it seems to be a friendship that is on nothing close to equal terms. If he desires to talk to me -- even if he says he does, then forgets that he ever said anything to that effect -- it's his choice to text me or to call me (occasionally he does not text first, though typically he does. If I were to really want to talk to him, the best possible answer as I can see it would apply is, "Tough shit,"  though I was never told such in so many words. My feelings were bruised by the callousness of the handling off situation, and left me in doubt as to my status a a friend to this person.

For some reason -- and I do not entirely rule out misperception or hypersensitivity on my part --  I felt an immediate impression of relationship-oriented awkwardness to my having mentioned the earlier suggested telephone conversation. I was left with the feeling (again, which may have been nothing more than a misguided feeling on my part) that I was in some way being considered a pursuer or an aggressor of sorts, though the telephone conversation had not been my idea in the first place  My friend did not directly accuse me of any such thing, so I cannot unilaterally blame him for this or for any other feeling on my part. Still, it was a most uncomfortable sensation.  I was left feeling as though I might somehow unwittingly or unintentionally be considered to be chasing the man, or at least, for lack of a better descriptive term,  creating the impression of doing such. This is an action in which I simply do not engage. even in kindergarten, when some little girls chased boys around the playground, I wanted know part in such activity and considered it beneath my dignity.

I immediately dropped the topic of any telephone conversation.  Times attached to text messages are unclear; I don't recall when either he or I last sent a message to the other.  It's been longer than twenty-four hours, but we've never made it any sort of point to message each other on any sort of a regular basis. The interval between our most recent text messaging is not of significance. On the other hand, if I even as much as exchange a text message with this person again, which will not happen unless he initiates the exchange, I certainly will never again broach the subject of a telephone conversation between the two of us. 

I suspect I've somehow, by my reaction to this situation, convinced my friend that I am more emotionally needy than to be  worthy of his or anyone else's genuine friendship. We all know too many basket cases in the flesh to encumber ourselves with those slightly shaky individuals who have somehow managed to attach themselves to us through the cyberworld. I've certainly found such characters out their in the vast online world myself. We all have enough questionable people in our real worlds without taking on the unstable cyber-population among us. My mom tells me my friend is too busy to waste his time assuaging my ego. She's probably right. Live and learn.  

I'm reasonably certain I never in my own mind built up the intensity of our friendship in my mind to a state it existed beyond what it was in reality.  I never harbored any illusion that my friend would be the officiant at my own wedding ceremony or that he would surprise me by unexpectedly showing up at my medical school graduation.  I always knew my place in the grand scheme of all things relational, which would have placed me in terms of priority behind my friend's immediate family, his extended family, his real friends, his co-workers, he lowest of his low subordinates,  his closest cyber-friends. his bookies, his hair stylist, those who remove his trash from the designate receptacles regular, yard waste, or recyclables from their designated bins placed on the streets, probably his mail man, the technician who schedules his prostate exams, his usual FEDEX deliveryman, and his pest control person as well. Still. I feel somehow cut off by his responses to my questions.. Following my recent romantic breakup, this all happened at a time when, emotionally speaking, I could ill afford to be discontinued in the manner in which I was by someone I had considered a good friend.  The pain isn't literally killing me (I admit to a pet peeve concerning use of the word literally; were the pain I suffer literally killing ,e, I would be either dying in a hospital, or holed up in a corner somewhere, most likely bleeding out. In any event, I wouldn't be typing my "woe is me" story so that I might have the sympathy of all who read it), but it I can honestly admit that the pain makes me want to dig a hole, crawl inside it, and cover the top with a  heavy board, leaving enough air so that  I can breathe but not to allow any light or extra air inside.  Emotional pain isn't as unlike physical pain as those who have lived truly charmed existences would ever know.

I cannot know everything that has gone on nor presently is going ion within my friend's marriage, nor do I have any need to know. Perhaps my friend is wise to snub me at the present time. His  feeling ever so slightly insecure in regard to his  friendships with other females at the moment (assuming the insecurity extends to friendships with females beyond myself) may be for reasons quite logical to anyone in possession of all the facts. Maybe the wife, were she to know of my existence,  would have visions of me as being some sort of young femme fatale, as opposed to the more likely scenario that, were I to be introduced as the love child of Bernie Sanders and Paris Hilton, who unfortunately emerged looking a whole lot more like Bernie Sanders than like Ms.Hilton. (As a saving grace in this fictitious debacle, were I the product of such a union, my intellect would have to be said to more closely resemble that of Senator Sanders than of Ms.Hilton. ) Few to whom the story would be told would be unlikely to have reason to question the account of my parentage. It's far more plausible that this particular story of immaculate conception would have a ring of truth to it that would any of the other  immaculate conception stories that have come about in the past two millennia, give or take a hundred years. For that matter,  no one ever suggested that the conception necessarily occurred immaculately. Ms. Hilton hasn't always been discriminating with regard to her choices in coital relationships.

The situation is not improved by the reality, to me anyway, that at least one mutual cyber-acquaintance and probably a few real-life ones as well would and/or will be most pleased and/or amused by this recent development. Adding publicity to humiliation typically only serves to intensify it. I know this very well. I  was, just about a month ago, unceremoniously dumped by the guy I was dating, who was arguably the best-looking male in our cohort. I'm still the souce of many jokes over that incident, with many casual observers wondering what a man so handsome would ever see in a female who looked the way I look.. Some days it's all I can do to force myself to  leave my condo in the morning for work.

Meanwhile, I must finish my subinternship, the remainder of the this academic year, then ultimately my internship and residency, and I must do it without unnecessarily bogging down any actual friends I've been lucky enough to hold onto, because they also have their own problems with which to deal, and they will not continue to be my friends if being in my presence does nothing except to drag them down with me. Three-and-one-half years ago, I would have guessed that life would be some version of smooth sailing by now, which only goes to show just how little I knew then.