Vampires, Jehovah's Witnesses, The Probability of My Survival, and Kinks Even Weirder than Adult Babies

I'm still sick from powerful medication and am still looking very much like the twelve-to-sixteen-year-old-girl who was taunted as  "Anorexis," but I'm beginning to figure this thing out slowly. I take the medication at 6:00 a.m. It gradually works its way into my system until by 10:00 a.m., when I am worthless to the human race unless someone is conducting some sort of research for which they actually need, for research purposes,  vomitus, or even perhaps something that is expelled from another orifice.  My brother (How does he know some of such things while others elude him seemingly forever? Some sitcom -- "Scrubs," I think,  had a presumably intentional error of displaying a chest X-ray backward on an illuminator. Matthew used to watch the show each morning while he ate breakfast our first year of med school, and he never commented on it. Curiosity got the better of me, and near the end of the school year, I asked him what looked funny about that X-ray. He had no idea and presumably had not yet, after nearly a year of anatomy lab, learned the differences between the right lung and the left) tells me that there are people who will actually pay for such by-products to fulfill their kinks, but I want no part of such sick-in-the-head-ness. And to think I thought adult babies were weird. I understand why someone might want to illegally purchase one of my kidneys or maybe even my old kidney stone, but barf? Holy Mother of God! To what depths is the world sinking? P.S. If you want to know anything like how best to sell the scrapings from under your fingernails or your used contact lenses, ask me and I'll check it out with Matthew for you. He's sure to have plenty of insight.

Then I'm out of commission for the rest of the day. I sleep or don't sleep,but even if I'm lucky enough to sleep, I feel as though I am dying. The time does pass more quickly if I sleep, though. If I have the TV on or have any music playing when I sleep, it all gets incorporated into a sort of Bohemian-Rhapsody-level-of-weirdness dream from which I try to emerge but can't, where it feels like I'm smothering in my sheets or my arms are tangled under me and I cannot free them to move. It could be a song as tame as a Mozart flute andante and it would still turn into a nightmare about vampires or Jehovah's Witnesses chasing me.

Somewhere around almost 2:00 a.m.I  wake up and start to feel almost human again. I try to get fluids down, because if i cannot, I have to have another iV. By 4:00 a.m., I'm ready to eat, as in ginger ale and soda crackers.  I won't absorb all the nutrients, but as bad as barfing is, it's worse to go through the motions when there's absolutely nothing to come out. Dry heaves are almost as bad as it gets. Two things are worse. One I will share with you, which is when the barf comes out of your mouth and nose simultaneously. The other one is too gross to share. If you pondered for long enough, you would come close to guessing correctly, so I'll leave it to you to decide just how intensely you want to ponder.

The epidemiologist I'm seeing told me that what I'm experiencing resembles the reaction to certain forms of  chemotherapy except that I'm not going to lose much hair, though if I stayed on this drug for long enough, she said, I probably would. It differs also in that, barring a positive test, I'll be done with it for good in something like 22 days. (I'm beginning to lose track.) She said it's also a lot like a major bout with hyperemesis  gravidarium -- the pregnancy-accompanying morning sickness that some women are unfortunate enough to experience that doesn't stop once high noon hits and often lands women in the hospital. Duchess Katherine, the mother of those adorable toddlers Prince George and Princess Charlotte (Jaci doesn't like them, but I find them perfectly charming) had a particularly nasty bout of hyperemesis gravidarium and spent time in the hospital with, I believe, both pregnancies. My mom never had the grave form of morning sickness, which was a good thing, as she barely birthed healthy twins once out of two tries even as it was. Had she been nutrition-compromised, I'm not sure what might have happened to me, as roly-poly 6 lb, 9 oz. Matthew was clearly the placenta hog of the two of us, with me weighing in at 2 lbs, 2 oz., or 2 lbs 4 oz., depending upon which birth certificate and hospital record one chooses to believe; as far as other matters are concerned, Mathew's level of acumen could only have gone in one direction as a result of maternal prenatal hyperemesis gravidarium,  and we all know he has few IQ points to spare as it stands..

I'm becoming one much like of those old ladies who talks about nothing but what ails her. I promise soon -- not immediately, but very, very soon, to change the topics of my discourse. 

Life Is Like a Box of Chocolates: Ex Lax, To Be Specific

It's two steps forward and one step back, but that's still progress, albeit slow and impeded. I made it both up and down the stairs on my own today, and I was able to coax my aunt's moronic dog back inside with the help of the Fedex deliveryman when she decided she would rather go with him than stay inside my condo with a person who loves her so dearly [sarcasm font]. I spoke with one of my favorite friends on the phone today. He was very busy and didn't have to take the time to call me, yet he did. My mother is back, which is simultaneously good and bad.  My sweet aunt convinced her, after a lengthy shopping trip, that this is the place she needs to be right now. My aunt even came with her.  To be perfectly honest, it probably would have been even better if just my aunt had shown up here while sending my mother on her merry way elsewhere, but life doesn't always work out perfectly.

Speaking of life not always working out perfectly, such is the state of my medication. I've been so stoned and/or sick that I'm not even sure what I've shared. I'm taking post-operative prophylaxis fr occupational exposure to body fluids of someone who very likely  does not have the human immunodeficiency virus. I'm not at liberty to share the circumstances surrounding my exposure. The hospital system with which my medical school is affiliated is concerned that the media would love the story and would be all over it, which would, in turn, bring on ambulance-chasing attorneys, in part because one person involved -- I shall not even state his or her position -- acted rashly and not in the best interest of a patient. Because of all of these political ramifications, I'm not at liberty to talk about something that very much involves me. I feel this is wrong, but what can I do about it?  I want to finish medical school, and someone connected with the school may be aware of my blog.

It is not totally my choice to undergo the prophylaxis routine. If I wish to continue with clerkship rotations at least once my 4-week tests come back clear, and possibly until my 3- and 6-month checks come back clear, I am at the mercy of the school and must take the drugs. If a particular pharmaceutical cocktail is making me especially ill, which was what happened, I have some say in changing the particular drugs. Still, I'm relegated to a three-drug treatment, which is most effective if the virus is actually present. The part of my brain that thinks logically (though some would say that no part of my brain actually thinks logically) says if I'm going to do this at all, do it the right way; take the three-drug treatment. The half-@$$ed two-drug treatment is merely hedging bets, and it will still make me sick, though not quite so sick. There is wisdom in doing it right or not doing the treatment at all.

What bothers me most about this situation, in addition to the forced confidentiality (I'm probably going further than my superiors would prefer simply with the authorship of this blog) is that I am forced either to undergo this treatment or to place my participation in my medical school program on hold at least until my three-month-check. Doing such would not allow me to graduate with my cohort, and would also likely prevent me from obtaining a match and beginning my internship/residency in the summer of 2018. 

What makes this all the harder to swallow is just how low is the risk of exposure from the patient from whom I was exposed.  No one is zero risk, but let's just say for the sake of argument that  Big Brother went crazy in the form of Obama Care going on steroids, metaphorically speaking. The government decided, in my analogy, that in order for our collective medical expenses to keep us from going under financially, that everyone in the U.S. had to have a needle partner, and an unrelated one at that, with whom he or she must share hypodermic needles. (The unrelated part would be because some people have no relatives, and we have to make it fair.) I know this sounds crazy, and it is, because I am on drugs right now, but please humor me and hang with me  for just a moment. 

So each of us has to find a person unrelated to us, and possibly even outside our social circles, with whom to share syringes, hypodermic needles, IVs, scalpels, and the works.  The person whose body fluids were exposed to me is quite possibly the person I would choose. She's clean. The least  safe thing about her is that she is an elementary school teacher. A kid may potentially spit at her or bite her someday. Otherwise, her health habits are beyond reproach. She has more to fear from me than I have from her.  

So with such a low-risk subject, why am I being forced to undergo this treatment regimen? I can understand exercising extra caution with regard to what procedures I'm allowed to perform until my testing comes back clear. Frankly, prior to my HIV exposure, I had already performed multiple procedures that third-year residents are not supposed to undertake. I'm way ahead of the game at the moment. I can afford to step back and watch for a month or two or three as others take the lead in procedures.

The bottom line here is that I'm ordinarily a cautious person -- not so cautious that I would not have done what I did in the first place that caused the exposure --  as I reacted on impulse. Those of us who enter the profession I am entering should be doing so with the intent of saving and/or improving the quality of others' lives. If I had the opportunity for a do-over, I wouldn't change a thing. I did what I thought was right, and I still think it was the right thing to do. If another person whose identifying information shall be withheld had done the right thing as well, I might never have been in the position to have done what it was that I did, but that's really neither here nor there.  My point, after all has been said and done, is that I think, even given all the information I have regarding the clean lifestyle maintained by my source of exposure, I still would have elected to undergo the post-exposure prophylaxis.  My quarrel with the process is that it should have been my decision without the heavy threats having been hung over me.

Regarding the title of this post, I thought of it myself, though I was far from the first person to coin a similar expression.  Its pertinence is to the effects of one of the new drugs I'm taking. I now not only have to worry about vomiting, fainting, dehydration, and low blood pressure: I now have the ghost of Montezuma haunting me.

Why is it that, in going through this treatment regime, I always feel best between 3:00 and 5:00 a.m? It's a time when it's probably least productive to feel at one's best.  I suppose I should consider myself fortunate that there is any time at all in a given twenty-four-hour block that I don't feel like euthanizing myself. Count your blessings. Name them one by one. (It's a Mormon hymn, though fundie Protestants may use it as well.)

Highway to Hell

My mom is tired of my negative attitude and is leaving to stay with her sister an hour-and-a-half  or so from here to spare herself the agony of listening to me barf and complain that I'm feeling ill during the time that I'm not barfing. I acknowledge that I'm not seven years old any longer and that I am capable of throwing up without someone else giving me directions. Still, I thought mothers were supposed to be more sympathetic than that. 

If she just needed to get out for awhile and planned to come back, I would certainly understand that. If she called my dad and asked him to come home or at least come check on me, that, too, I would understand. I don't believe either of such things is the case, though.

I am at home and not in the hospital because someone is supposedly here with me. I am capable of managing my own IVs, although if I had to take out the one that is currently in and couldn't find a good vein in my right hand (my veins have all more or less been used up) I would probably be stuck, as I'm not quite good enough to insert IVs using my non-dominant hand. 

A situation happened at the hospital last week that exposed me ever-so-slightly to HIV. The potential exposure is real enough that I have to go through post-exposure prophylaxis, mainly because of the nature of my work with patients; if I were a regular person working in a regular job, it would likely be determined that the risk of becoming seriously ill from the treatment was greater than the risk of contracting HIV; at the very least, it would be my prerogative to opt out. Because  I  work in the health care field, however, my choices are to continue the treatment, which will last for another 23 days, or to opt out of my program for two months, then return in seven months and one day, presuming the test came back negative. At that point I will be almost a full rotation behind my classmates. i wouldn't be allowed to graduate with my cohort, and would have to finish my final clerkship rotation after everyone else had graduated. I would probably still be allowed to apply for a match for my residency, but it wouldn't be guaranteed, and I would have about 12 hours between the time I finished my final rotation and when I was to report for my residency. The worst part would be not being allowed to graduate with the rest of my cohort.

The situation is highly confidential. a few people in my real-world life know that I'm receiving post-exposure prophylaxis.  An even smaller number know why. I'm not allowed to talk about the situation because the hospital administration wants it kept very quiet i talked to four people online that I trust not to say anything to anyone that would get me into trouble. I shouldn't have done that, but I trust them not to post anything or to try to find my medical school and to call someone there and say, 'Do you know what Alexis just told me?" I trust them all to have more important things going on in their lives.  I I don't even know if it's OK to talk to a shrink about it. It's obvious that they're getting tired of hearing about it. I need to leave them alone. 

My dad probably knows something because he was in the ER when I was taken there this morning after a hypotensive crisis due primarily to dehydration. I don't know what he knows, though. If I said something confidential and then he in turn said something to the wrong person, I would be in trouble. Consequently I cannot say much to him. I don't even know if he's coming back here anyway. Perhaps he's going with my mom to stay at my aunt's house. My mom packed downstairs, and I'm stuck upstairs. I don't know what she packed.

If there were a fire (which isn't going to happen; I'm paranoid but not THAT paranoid), I could get myself downstairs and out of the condo. I couldn't make it back upstairs, though, so getting  7-up or ginger ale or crackers isn't a good idea because no sofa is close enough to the bathroom, and I'd be stuck barfing in the same trash  receptacle all day. Even making it downstairs and to the kitchen is almost unmanageable for me anyway.  So I'm essentially limited to tap water.

I have four bottles of Ringer's solution. If no one comes back within twelve hours, I'm out of the stuff.  I do have syringes filled with the post-exposure prophylaxis.  I can inject myself in the thighs with the stuff, but that's the only intra-muscular site I can reach myself that I'm supposed to use. I'm not supposed to use my arm, but I could reach my right arm with the left. I'm not supposed to repeat a site for at least five days, but it may become necessary.

Does a person go to hell for saying that her mother is a b!tch? if so, that's probably where I'm going.

When the (Student) Doctor Becomes the Patient

This picture has no real relevance to anything in this blog or elsewhere. I just saw it and liked it.

My schedule has been changed once again. I'm sure that whoever is in charge of making schedules is starting to hate me, but none of this is happening at my request. Beyond that,  all the people on the payroll --  not including my peers or me, as we're not getting a red cent other that the free meal (and I'm using the term meal  loosely, as what comes out of our cafeteria posing as cuisine is probably closer to soylent green than to actual food, but that's another. topic for another day -- that is provided if we're stuck on the premises for more than eighteen consecutive hours -- are lucky to have jobs in this economy. So he or she should suck it up and not complain about having to revise my schedule roughly three times each week, right?  

In any event, it was determined that it would be imprudent to put a clerkship student  as weak as I am into the psych ward. At my strongest, I could barely hold my own against someone who went bonkers and decided to go into attack mode. Right now, I would be unconscious before I even realized there was a problem. I may be stronger next week, but it's not realistic to expect my improvement to be substantial. I'll still be having the drugs injected into my body on a daily basis. I now have twenty-three more treatment administrations to go. A week or so after that, I should be within  reasonable distance of where I was before this fiasco began.

Hence,  on Monday of next week I shall begin an eight-week rotation in Internal Medicine. It's not the most exciting rotation on the planet, but neither is it the least exciting, and it's the basis of what all of us will someday do, no matter what our eventual specialty.  It's a requirement for anyone completing his or her first twelve months of clerkships. I was originally scheduled for it in the spring of 2017, but it's been bounced up a bit for me. The timing is actually good in that I will miss out on less by only talking to patients and observing for a couple of weeks until I get my medical clearance. There'll be plenty of time for greater involvement later.

I'm sad about not getting to OBGYN until later now. My psych rotation would only have been for three weeks. Now OBGYN in delayed until January. I'm more excited about the OB part of OBGYN.  Who wouldn't be, other than maybe Donald Trump?  All the content must be covered, though. 

I didn't pass my physical for pediatric oncology today.  They looked in throats , checked temperatures, and looked for obvious signs of contagious illnesses.  In checking temps, they were looking for fevers, but my temp was 95.6. A slightly subnormal temperature is normal early in the morning (several of my peers were running in the 97-degree range), but it shouldn't be three degrees below normal.  When someone checked my pressure and found it almost impossibly low, the lead doctor asked, "Does she even have a pulse?" He told Professor Larry Bakman that he wasn't sure whether to send me home, to the E.R, or to the morgue. He was aware of the status of my medication regimen but didn't expect the situation to be quite so grim.

I told them that my dad was finishing up a shift in the E.R., as he does ten times per year to ensure that he has sufficient patient contact hours for licensure. Someone  called for a wheelchair, and Larry [not his real name; I would never be so disrespectful as to refer to a professor by his actual first name] rolled me into the elevator, out of the building, and into the E.R. at the adjacent hospital. The problem was primarily dehydration.  Much to my chagrin, I had to be hooked up to in IV again. Th one good thing is that since I'm hooked up to an IV anyway, I didn't need and injection yesterday and won't need one today, either. I'll probably be off the IV at some point today, but at least two painful injections have been avoided.

Larry and my dad decided I will not accomplish anything by trying to work in pediatric oncology this week. If I don't make it to the staff restroom before hurling with each episode, I risk exposing them to body fluids. I would make it to a trash can, but there's still potential splashing. In a best-case scenario, I'll spend one-third of my time throwing up and recovering before getting back to the children. The director of third-year clerkships was consulted. It was determined that next year I'll need to complete a clerkship in oncology, but it's assumed that I'll pass the pediatrics exam next week at the conclusion of the rotation. If I don't and if the sections I fail are related to pediatric oncology, I'll need to spend four Saturdays or Sundays working on the pediatric oncology floor, then  re-take the exam. I don't anticipate the exam being a problem as exams are my forte, but if it is, i'll gladly give up the four weekend days. 

I'm now confined to my house util Monday. I'm not being expected to make up the lost time because it happened as an occupational hazard.  If I were an intern or resident in the same situation, I would continue to receive pay.  If I didn't have medical personnel here, I would possibly have to stay in the hospital, but my parents are here until Monday, at which time they leave for a Pacific Northwest cruise. Matthew, when he's here, can deal with IV s as well, and so can I. I can both change bags and reinsert my own IVs if necessary. I've done it before.

I slept so much yesterday that I'm awake now, but I can barely make it from my bed to my recliner or to the bathroom. My dad piggy-backed me up the stairs tonight while my mom held the IV pole. Pretty much everything I need is within my reach. 

At some point I'll probably grow bored, but right now I feel too yucky to even contemplate boredom. I'm just grateful I don't have to figure out how I'm going to get myself to work tomorrow.

The effects of this drug regime have been described as being a great deal like chemotherapy except that a patient doesn't lose his or her hair.  If a person continued with the drugs for long enough, supposedly he or she would lose hair.
It's a real quandary. If I were a private citizen, I could make the choice as to whether or not to go through the treatment. Because I work with patients, however, the choice is not my own. I could drop out of the program for two months, then be tested and re-join, but I wouldn't graduate with my class. The source of my contact has tested negative and presumably will continue to do so. She's an extremely low risk for HIV. Still, she's a teacher. Teachers CAN be exposed to body fluids, and they may not even remember it having happened. My mom says she's been bled, drooled (the drooled on was by a special-needs kid), and barfed on by students, and she only taught for two years before moving up the food chain to psychologist and administrator. If a kid needs help and a teacher is in a place where rubber gloves are not readily accessible, a teacher usually goes to the kid's aid anyway. While my source is of low risk, she's not of zero risk. It's probably smartest to go through this treatment regimen. Now that I'm spending a third of my time either throwing up or recovering from the immediate after-effects, it doesn't feel very smart.

My dad brought home four different anti-emetic (anti-barf) drugs to try.  If one seems to work, great. If it doesn't, I need to wait four to six hours before trying another one. I can at least take Benadryl, which helps to some degree and doesn't interact negatively with anything else I'm taking. There are also a couple of benzodiazepenes I can take. They don't really reduce the level of my nausea. They just cause me to care less.

In the event that you did not know this, it is only fair that I warn you: learning to be a doctor can be hazardous to your health.

When the night has come and the land is dark

the famous pie-eating contest scene from Stand by Me

My life has sunk to the level of one giant barf-o-rama. (I give credit to Stephen King, who may have been the first person to use the term in print in his novel/screen play Stand by Me. Great movie, incidentally.) I could throw away my clocks and tell time by  the onset of each cycle of cookie-tossing. It happens every half-hour, almost on the half-hour. The onset happens technically three minutes past each hour and half-hour..

Becca suggested Benadryl or Ativan. Benadryl might possibly work. Ativan wouldn't because it would knock me out. My initial dose was given at around 6:00 a.m., and the schedule, plus or minus an hour or less, needs to be maintained. I have to work after the dose.  I am trying Benadryl. I have nothing left to lose.

Starting tomorrow, we're going with injections instead of IV administration. This means  I no longer need a saline lock, and that I'll have a moderately painful intramuscular injection each day, but then will been done with it, minus the barfing and feeling horrible, until the next injection twenty-four hours later. I'm  glad to have the saline lock out of my hand, as it was inconvenient, though not so inconvenient as being hooked to an IV pole. Intramuscular injections are normally given in the hip, thigh, upper arm, or buttocks. My upper arm is too thin (the other parts are borderline, but they;ll have to do), so I'm limited to the other three. With having a left and a right of each, every six days I'll have to re-use each site. Twenty-four  more days of injections means each site will be injected four times. It's not optimal, but it's far better than either the oral or the IV alternatives. Anything resembling a workout is off the table for the next 3 1/2 weeks, but my level of energy is and probably will continue to be such that  it wouldn't have been possible anyway. Just dragging myself to work is almost more than I can handle.

I'm dreading with a capital D the psych rotation that follows my final week of pediatrics, which is to be spent in pediatric oncology.  Most of the psych rotation is spent among people who are not a lot crazier than you are or I am. Whether or not that is a good thing is something I'll leave for each reader to determine for himself or herself.  In almost every rotation, however, someone is attacked by a truly deranged patient. With my luck being what it is, I'm not overly optimistic.  I'll walk into whatever facility I'm assigned each day with the eyes in the back of my head fully functional.  I've worked as a substitute teacher in a middle school. I'll consider this job the equivalent of the sub teaching job times roughly 1000 in terms of the degree of danger.

Meanwhile,  I'm trying to barf enough today that there will be nothing left to throw up tomorrow, or at least it appears that I am spending sufficient time worshiping the porcelain goddess enough for such to happen, and I'm trying to put a positive spin on it. The pediatric oncology patients deserve my full attention tomorrow, or at least a decent uninterrupted game of chess or Candyland.

I hope the weekend has been enjoyable for everyone else. If you're a fantasy football participant, I hope your team did well. If church is your thing, I hope your musicians didn't screw up the hymns to the degree that it ruined the service for you, or that the pastor didn't ramble on and on about a topic that had no interest to you. If you live on the east coast, I hope that you were unaffected or at least minimally affected by Hurricane Matthew.

My brother is such a cretin that he considers the hurricane his personal hatchet man, and is rooting on the hurricane the way more sane (but sometimes still demented) people cheer for their sports teams. My mom, who is here for the week because someone for whom she covered is covering for her in return for 2 weeks, tried explaining to him that lives are at stake, and people stand to lose their homes and everything they own. "I'm really sorry for them," Matthew responded, seemingly in sincerity, then went on to shout encouragement each time another report of the hurricane came on the telly. I really hope his residency is on the east coast, right in the eye of some future hurricane, so that he can more fully understand his foolishness. Then again, we all knew of Matthew's cognitive challenges long before this hurricane became the precursor of a tropical storm, and foolishness of such magnitude is difficult even for the intelligent to grasp.

The Game of Life, and How Best to Play It

Most of these little capsules and pills don't taste substantially better coming up than they did going down.

Board games have fallen somewhat out of vogue these days. Does anyone here remember "The Game of Life"? It was, if I recall correctly, much like "Monopoly" except with a distinct pro-college-or-university agenda. In playing, one was forced to  decide very early in the game, once completing high school (I'm not even sure there was even an option for not completing high school), whether to go immediately to work and to begin earning money, or to delay work and earning power by first obtaining a college or university education. The outcome was  rigged in favor of those who completed college.  i don't remember if there were options for graduate or professional school and, beyond that, options for sub-specialization in a field such a medicine. I ought to find it the next  time I go home to my parents' house, or if it's in the game room on the pediatric oncology floor, where I will spend next week.

When the topic of the game came up in casual conversation recently,  Cool Guy suggested that, if such has not already happened, the game is ripe for an update based upon people choosing obscure majors for which they cannot find jobs in their fields of education, or for those who completed their educations while incurring tens of thousands of dollars of debt in student loans. Some of those with heavy debt, (I'm talking about real-life college students now; not people playing "The [board] Game of Life") who chose majors wisely,  stand a reasonable chance of paying off their loans early in their careers, or at least prior to projected retirement age, while others may as well add the  student loan payment to their projected monthly budgets for as long as they live and breathe. Another consideration is that "college" and "work" are not mutually exclusive.  An ambitious young person (an obvious person comes to mind here: I'm sending  shout-out to Judge Alex Ferrer of "Judge Alex" [now available in rerun format on a local channel near you] TV show fame) who obtains a full-time job, particularly a young person who worked before graduating from high school and gained adequate experience to be considered for an above-minimum-wage-paying position, and who took advantage of options such as community colleges, which typically offer the lowest possible cost for the first two years of a student's education, may have the best of both worlds. Furthermore, academic merit scholarships and advanced placement courses figure into the equation in the real world.  In short, "The Game of Life," as it was played when i was a child, is now both obsolete and misleading. I may find out the nitty-gritty details next week if "The Game of Life" is one of the board games I end up playing while interacting with oncology patients and helping to distract them from anxiety and physical discomfort as they pass the time waiting for more tests, procedures, and test results.

It's been a rather event-filled week for me, with much of it on the rough side of exciting.  I wish I could say more about the main event, but that is someone else's story to tell, and the person will tell it if and when he or she is ready. All that is left for me to do is to ponder the miracle of life that we see every day yet all too often take for granted, and to take anti-exposure prophylaxis (PEP) because of an unlikely but still possible exposure to the human immunodeficiency virus, more commonly known as HIV.

My possible exposure is through cutaneous non-intact skin. Even if the source of my exposure were HIV presently positive, with timely treatment my risk would be something like 0.09% because of the rapidity of my treatment. The imperative is for the exposed person to receive anti-exposure prophylaxis within 72 hours, and the goal is for it to be given within 1 hour. I received it within 20 minutes of exposure. The quick-result test indicated that the source of my potential exposure is not HIV positive. The more accurate lab tests probably come back tomorrow. The sucky part of it is that I need to continue with the post-exposure prophylaxis for the unlikely possibility that the source that exposed me is, himself or herself,  in such an early stage of HIV that the person is not yet showing up as positive but eventually will. It's incredibly dubious, but were it to turn out that the source was positive, I'd have no one but myself to blame for not having followed through with the post-exposure prophylaxis.

At this point, I cannot tolerate the oral forms of the antiretroviral drugs. If I throw them up, even (I know this is gross, and I apologize) if I pluck them out of wherever I threw them up, the experts cannot with absolute certainty determine how much of the drug I absorbed, so they can't necessarily assume it is safe to give me again the drugs that turned up in the vomitus. At this point, the best alternative  is intravenous administration. There's a possibility at some point that simple injections might be another alternative. (Who would ever have thought that I, Alexis, who lined the floor of my bedroom with aluminium foil, in addition to attaching jingle bells to the handle of bedroom door, in order to prevent my father from sneaking into my room while I slept and giving me a flu shot just because I hated injections in any form that much, would concede willingly to undergoing injections in favor of swallowing pills? For the record, my subterfuge wasn't successful. My dad was able to slide the business end of a pie server through the crack of the door to silence the jingle bells, and he silently cleared a path through the aluminum floor covering to make it to my bedside and to inject my arm with the dreaded inoculation before I woke up and, at 5:00 a.m., alerted the entire neighborhood to the injustice of what had just occurred.)  The IV administration is inconvenient, and it deprives me of much-needed learning time on the job. Still, it's the only alternative at this time, and it's also a way for me to obtain much needed hydration, because the IV-administered drugs still cause me to hurl; it's just that I'm not hurling pills that I just took and very much need to stay in my system.

Next week I report to the pediatric oncology unit. Professor Larry Bakman has offered to go with me the first time I enter the unit. It's a scary thing, and I had considered asking my dad to accompany me, but at some point my reputation will be harmed by the perception of others (deserved or undeserved) that I cannot accomplish anything without Daddy helping me. If Professor Larry just happens to turn up when it's time for me to enter the unit, no one will know why he's there and won't necessarily connect him with me. He said it's not something he would do for just anyone, but that a twenty-one-year-old prospective physician deserves more consideration in that regard than does an older med student.

Before we're allowed even onto the pediatric oncology floor, we're subjected to a mini-physical exam. Professor Larry can pretend he was asked to show up to help with that. We'll still be subject to some scrutiny each morning, but will be expected to self-monitor to some degree once we've been told for what to look. I will probably pass the physical despite my less that optimal condition at the moment. I've been told to interact (though not physically) with the patients and to observe procedures, but not to perform or even to assist in procedures myself. I won't be inserting any IVs for the next four weeks or so, except in myself.

I assume the next week will be filled with a great deal of violin and piano playing for patients, puzzles, and a lot  of Uno,  Candyland, and other board games perhaps including the aforementioned 'The Game of Life" (video games are provided, but we endeavor to get the children to do something besides X-box, Wii, and other electronic activities; we should serve as good examples to the parents - to remind them that something doesn't have to be plugged into an electrical outlet or to contain batteries in order to be worth doing) depending upon the patients' ages, and a lot of talking to children, in addition to  a great deal of observation. Furthermore, I now have more than I previously had in common with the children receiving powerful drugs that cause their stomachs to evacuate their contents  on a regular basis. The children and I can commiserate with one another and compare notes.  In the past, I've been allowed to participate more actively in rotations than has the average third-year student. Now I will experience what it is like for most of the rest of them. 

My original schedule was for me to move onto obstetrics and gynecology following the pediatric rotation. I don't want to go into that rotation without the health clearance for more hands-on involvement in the procedures, so my schedule is being flip-flopped. I'm doing my psych rotation starting Monday. My OBGYN rotation will follow the psych rotation. While I'm disappointed not to be going directly to the OBGYN rotation, I greatly appreciate the flexibility of the person,  whoever he or she may be,  who made the change on my behalf. 

I am not nearly so jazzed about the psych rotation as I was by the prospect of participating in OBGYN, but I recognize how very fortunate I am  that those in power caused this change to happen. The psych rotation was not something I was anticipating with any particular degree of eagerness. Now, however, if I'm cornered by a dangerous patient, I have a secret weapon in my arsenal. "You don't want to mess with me!" I can tell a crazed patient. "I may very well be HIV-positive!"  Since I'm stuck with this limbo status, I may as well use it to my advantage in the psych ward. Additionally, I should remind myself and everyone else that not all psych patients are crazed maniacs. I was a psych patient, and not all that long ago.

In 28 days, both the potential source and I will again be tested. At that point, if nothing appears amiss, I will get on with my life. The source will be left alone entirely as far as HIV status is concerned from that point forward. I'll have 3-month and six-month lab checks -- possibly unnecessary, but because of the field I'm entering, i owe it to patients with whom I'll come into contact to do what is practical to ensure that I'm not infected.  At that point it will be time to leave well enough alone. I could also be carrying Lyme Disease, a latent form of the Bubonic Plague, Rocky Mountain Spotted Fever, or an undiscovered form of TB that isn't caught by routine skin testing. At some point, one must assume that all is well or one would have some indication to the contrary.

Meanwhile, the nausea just won't quite go away. I'm going to look like a bona fide anorexic or an albino Ethiopian refugee before this is over.  I'll try different anti-nausea drugs until I find one that actually works. My peers have been wonderfully supportive. They've made jello for me and offered to insert my IVs. They've offered to cover shifts if I can't drag myself to my assigned location. So far, I've managed to be there physically, though I've spent a fair amount of work time worshiping the porcelain goddess. I'd feel guilty for the amount of on-the-job time I've spent barfing, but we're not getting paid a cent. We're free labor -- practically slaves. 

The administration mysteriously turns up wherever i am entirely too often for it to be a coincidence. I've given up on thinking there's something subversive about their surveillance and am growing less paranoid. The deans and other important people not spying on me to ensure that I'm treating confidential matters as such, or, for that matter, ensuring that I am not attempting to exceed the scope of the training I've received thus far. They're checking up on me because they're concerned for me. Even as recently as a year ago, I may have had difficulty in accepting this, but a basis in reality has supplanted conspiracy theory in the default mode of how my mind operates. 

Meanwhile, if anyone knows of any great homeopathic remedies for constant nausea with frequent vomiting, I'll listen. I've gone through 1/4 of a box of ginger snaps as well as fresh ginger, and neither does a thing for me. If the remedy you suggest involves anything resembling tossing frogs' legs (fresh or freeze-dried)  into a blender, liquefying the frogs' legs with the blender's most powerful setting, and mixing the ensuing concoction with wine vinegar and vanilla extract, please do not take it personally if I neglect to try your magic potion.

Ciao. I shall try to get some sleep tonight, but I'm not overly optimistic.

This is one of the blast-from-the-past games in which I'll probably find myself engaging in next week.

Beach Party Minus Annette Funicello

Our gathering was smaller and somewhat mellower. I didn't notice any helicopters flying overhead.

I'm at a hotel near a beach north of San Francisco, though not quite as far north as I was when I had my little enforced vacation a couple of months ago. I'm sharing a hotel room with my medical school best friend, who shall be called Sophronia tonight, although she gets a different name almost every time I reference her. (I came up with the name Sophronia  because it was the name of one of Joseph Smith's sisters. I've never hear of anyone else named Sophronia. Have you? Anyway, someday she'll be comfortable being called by her actual name in my blog. Or maybe she won't. I'll honor her wishes. in the meantime, she'll get a different and possibly more creative name each time I mention her in my blog.

The room is comfortable, with two queen-sized beds. Actually, that's more comfortable for Sophronia than it is for me. I still prefer a twin-sized bed. It's cozier. Sophronia is almost my height, maybe  an inch taller, but she likes to stretch out. I could have ordered a roll-away twin bed to be delivered to the room, but the mattresses on the roll-aways aren't nearly so luxurious as are the ones on the permanent beds in the rooms. 

Our cohort, minus mostly just  the relatively few of us who were on some form of duty, met on a beach in the aforementioned area north of San Francisco for purely social purposes. 

One person not here tonight who had no weekend duty was the woman who sent the puerile yet toxic text to me following the event several weeks ago when I was denied entrance into a bar because the manager didn't believe that I was of age despite my valid California ID. My cohort mate has  gotten the cold shoulder from the group as a whole, and she hasn't responded in such a way as to make many people want to welcome her back into fellowship of the group. I'm staying out of everyone else's responses. I have no obligation to rise to her defense. I showed the text to exactly two people: Sophronia and Matthew. The author of the test showed it to far more people than I did. She was proud of the venomous nature of her text. Now she's sleeping in the bed she made for herself. The bed she's sleeping in tonight is nowhere near here. Perhaps she had a family obligation or a date with a really hot guy. or perhaps she felt unwelcome. I don't particularly care either way. When our paths cross, we do not greet one another.  That's not likely to change anytime soon. She's reportedly looking at other options for next year.  If such were to work out for her, that might be the best for everyone. Her continued participation in our program isn't harming me in any way, but I doubt it's doing many good things for her self esteem and sense of self-worth. Shortly after the incident, I would have said I hated her. I did, in fact, use that very word in a phone conversation with a friend. He responded as either my parents or pseudo-relatives would have responded, which was to say that hate is an inappropriately strong word and probably isn't one I should use in what is, in the long run, a situation that will fade into almost oblivious folds of my memory sooner rather than later. 
While I appreciate the wisdom of friends with more maturity and less stupidity than I, I look forward to the time when I possess sufficient wisdom and self-control to know to avoid using words like hate in situations that will inevitably pass without having to be reminded  to moderate my choice of words more carefully.

Among the attendees tonight was one of the people who was unkind to me in the previously described incident. Her role in the misunderstanding was that when I asked if we as a group could try the establishment across the street, as it was nicer than the original bar and its management might possibly acknowledge the validity of my driver's license, she responded, "You can go to the club across the street if you want, Alexis,  but we're all going here."  Her handling of the situation was on the ugly side, but I won't cast her in the role of the Anti-Christ. I say hello to her if I pass her in a hallway. I don't smile when I say it, but I at least greet her. I don't want to be her friend, but neither do I wish to be her mortal enemy. If we need to work together, I would prefer for it to be a civil and workable situation. In no case do I want my superiors to feel that they must schedule the two of us to be in separate rotations, as such would reflect poorly on me as well.  I was happy that she was here at our gathering tonight. Her attendance didn't in any way indicate her undying love, or even undying like, for me; it had absolutely nothing to do with me. On the other hand, the group as a whole had taken my side in the incident, and she heard the disapproval of numerous people, and not in the most diplomatic of terms. I'm glad any animosity against her was short-term and she hasn't been made to feel not part of the group on my account. I certainly wasn't about to volunteer to let her squeeze a rollaway bed into my hotel room. The last I heard, she was having a tough time finding anyone with whom she could bunk and wasn't crazy about springing for the full cost of a room herself. We can't all get what we want, and actions sometimes have consequences. C'est la vie if her difficulty in finding a temporary roomie had anything to do with the situation involving me. I don't really care one way or another about it as long as my brother isn't volunteering to share a room with her.

Matthew actually has a room with a two-way door connecting our two rooms. We didn't request it; it just worked out that way. He's sharing his two-queen-bed room with Timmy, who occasionally has time off now that he has advanced to the rank of second-year resident. He's obviously not technically one of us, but he as been adopted as our cohort's unofficial mentor. We invite him to social gatherings, and he comes when he can. He's not involved in a relationship right now, so if he's not working, he's usually available. I dated him briefly, but our family histories are so intertwined that it felt practically incestuous, plus he's five years older than I.  Right now, five years isn't such a significant interval, but more than two ears ago when we dated, the gap was less easy to bridge. He's brilliant, kind, gorgeous, and heterosexual; he'll be an amazing catch for some lucky woman.

We had a delightful gathering on the beach tonight with lots of food, plenty of hot and cold drinks with and without alcohol, some beach football and volleyball before dark, and recorded and live music after dark. I think I managed to achieve the often-illusive perfect buzz.

We're an amazingly cohesive unit. Conflict is unavoidable, but we deal with it when it happens. I can see all but one or two of these people being on my Christmas card list forever. It's probably a group that will hold five-year reunions, which I will make every effort to attend while ignoring my high school reunions, which have little meaning to me.

I fielded a few questions about  Friday's presentation to the psych and neuroscience students from cohort mates who had not known of my history; realistically, why should most of them have known?  there wasn't a lot to say. Shit happens. You thank your lucky starts that your injuries are not permanent, you deal with the psychological issues as quickly as you can, and you go forward with your life. 

I learned one interesting thing. A bearded man in a baseball cap wearing sunglasses sat in the very back row during my presentation. At the time, it reminded me a bit of a House, M.D. episode in which House himself wore a baseball cap and sunglasses as a disguise in order to, during a presentation,  harass a former medical school classmate with whom hed'd had a long-standing feud. I hoped the person wasn't disguising himself similarly in order to harass me, but more than that, I hoped it wasn't anyone who might be stalking me. I learned from my classmates that it was Professor Larry Bakman. He wanted to hear my story in my words, but thought his presence might be unnerving to me.  I'm not certain whether his disguise or his unconcealed presence would have been the more unnerving, but, just the same, i can appreciate his thoughtfulness. He did what he believed would be the lesser of the stressors as I would be impacted, and even risked looking a bit silly in front of his peers in doing so. It was an act of kindness for which I am appreciative.

Tomorrow (technically this) morning we have a banquet room reserved for a late brunch buffet. It won't being until 11:00 a.m. Some of us will head directly back to our homes near the medical school center, while other may hang around on the beach for more socialization prior to making the return trip. I haven't yet analyzed traffic patterns, which will be the determining factor for when I leave, though i'm traveling with Matthew and Sophronia, neither of whom is as stressed by traffic as am I. My suspicion is that we'll be among those spending time on the beach and departing later.

I need to be on duty early Monday morning in the E.R. of the children's hospital. It's not like the surgical rotation, where I needed to read all records for an hour before anyone else connected with the first surgery was on the scene, necessitating a 4:30 arrival time.  My shift begins at 6:00 a.m. on Monday. As I'm not replacing anyone else who will be going off-duty, I won't have to be present for any briefings. Still, I would be prudent to be dressed and in place by 5:45. I've gotten a bit lazy in the last two weeks of outpatient pediatrics, when I had only one early day -- the one for the twin c-section - but, overall, a 6:00 a.m. call time is practically considered sleeping in.

I wish more nights in my life could be like tonight was.

Alexis the Unconquerable

I haven't mentioned something because even thinking about it and preparing for it has been stressful enough that sharing the details with anyone in writing or in any form has been more than I cared to do.  Now that the deed is history, however, I can probably gather the courage to recount the details of a recent and rather daunting task.  It involved serving as a guest lecturer for primarily first- and second-year students in "Practice of Medicine" and neuroscience courses.  The topic of my presentation was  my own experience with Post-Traumatic Stress Disorder and the events that, for me, precipitated the condition. Clerkship students currently in the psychiatry rotation were required to attend, and numerous psychiatry residents and some fellows were present, as well as faculty members and people whose identities were unknown to me. I spoke to a packed house in a large-ish auditorium-style lecture hall.  As someone who doesn't aspire to be the center of attention in most situations (if I'm the featured artist in a musical performance, I do expect that attention will be paid to me and would be affronted if were not given, but that's basically the lone exception), having everyone stare at me as I recount highly personal experiences is not exactly the stuff of which nightmares are made (the events about which i spoke are the ultimate fodder for nightmares), but it was still stress-inducing. To express it mildly,  I'm relieved to have the experience behind me.  In terms of class presentations of which I've been required to be a part, my expectations for the attention of the audience were based primarily on the premise that if I didn't have it, it would have meant either that I was doing a lousy job in my presentation or that the audience was disrespecting me, neither of which would have been acceptable. Still, for the most part, I'm far more comfortable with a background role or, even more so,  with being an attentive audience member than with being a presenter.

In one particular class presentation I was required to make in my pre-clerkship years, I dressed a bit [for me, anyway; I'm usually buttoned to my collarbone and otherwise well-covered] provocatively with the hope that I would at least have the attention of the males in the group. It worked. In this situation, I didn't feel that dressing in even a mildly sexualized manner would have been appropriate. I thought it would be more fitting for them to see a version of me that was closer to the person I was at fifteen, which was my age when both trauma-inducing events happened to me.  I didn't put my hair into French-braided pigtails tied with pink ribbons, but I wore a pale polo shirt with slacks, and I probably did not look eighteen, much less the nearly twenty-two years that I currently am.  I wanted my audience to get that what happened to this person who is youthful in appearance even today occurred a full six years ago; there was nothing sexualized about my appearance at that time that would have provoked the attack, if a sexualized appearance ever provokes an attack, which it most definitely does not. It was truly a crime of violence, in this case against a child. Not every female is a little girl at fifteen, but I was very much so.

One's medical history is detailed in one's application to medical school. The members of the selection panel who view the medical history are, for all intents and purposes,  bound by the same HIPAA regulations as would any medical personnel be. It is, nevertheless, considered significant by an applicant's interview panel and is likely discussed both among the panel members and with the applicant. Medical school is a rigorous process. Few individuals are likely to be allowed into a medical school program without major accommodations if they lack the strength and vitality to maintain the required workload. It isn't leaps and bounds less physically demanding than training to be an astronaut. 

My physical and sexual assault, as well as my experience of being trapped alone in a smoky home in a third-floor attic in a severely mobility-impaired state, and the subsequent PTSD that developed, as well as the treatment that followed, were addressed by the panel. No member of the panel was insensitive in asking questions.  I believe their collective intent was to ensure that no lingering issues related to the events would negatively impact me in performing my duties. Would I be uncomfortable in examining or treating a rape victim in an emergency room was a question I recall. I was able to honestly reassure the panel that, if anything, my experience would make me more qualified and effective than would be the average practitioner in such a situation and I would probably be the physician-in-training or intern  of choice to assign to that patient if the E.R. had the luxury of making such choices on a given day.  

The panel was also curious as to the nature of my treatment, and I was able to discuss it with them comfortably. I mentioned the name of my primary care provider during my inpatient stay and during the outpatient follow-up treatment. My psychiatrist was a graduate and resident of their institution. Most of them knew him personally. I was asked if it was acceptable to me for them to discuss my case and treatment with him. I replied that I had no reservations with their doing such, and offered to type and sign a waiver to that effect at the conclusion of the interview. This was all before the interview got really weird -- before they brought out musical instruments for me to play in order to ensure that I was not padding my application with skills I did not actually possess.

At one point during the interview, one of the panelists asked if I would be willing to serve as a guest lecturer concerning my own experiences as a sexual assault victim, a mental health patient,  and recovering PTSD patient. I told him that at that particular moment in time, such a task was more than I was capable of taking on, but that, given a few additional years to distance myself from the events that took place, I would consider it.  It's been a few additional years. I was asked, and I chose to oblige the person who asked.

I don't claim to be 100% recovered six years later; it's an ongoing process, though I'm well on my way to recovery, and I do intend to recover fully.  I don't have a precise timeline for the recovery process, but I can say that twenty years from now, I don't wish to still consider myself a sufferer of PTSD. Somewhere between now and then, I expect to have come to terms with what happened, although I may always be sensitive to the smell of smoke, and I may be cautious in terms of entering public restrooms for the rest of my life.  That's probably just who I am and will always be, though it won't necessarily mean I'm still suffering from PTSD.  If a young child with even a hint of intelligence touches a hot stove, he or she is not likely to repeat the mistake. If a person has ever been hit by a car, chances are that in the future,  the person will always look both ways more than once before crossing a street. If a person has been attacked by a Rottweiler, he or she will exercise caution around large dogs. It's a natural consequence or a sign of intelligence if the definition of intelligence is one's ability to adapt to his or her environment, but, at some point, not necessarily still PTSD.

If public speaking is difficult for me when the topic is one that is in no way sensitive to me to the extent that I'm willing to dress in borrowed zebra-print shorts and a clingy top to ensure the attention of at least part of the audience, a person can probably imagine the level of stress related to speaking to an even larger group about something that is intensely personal to me. What if, in virtually baring my soul to my peers, slight inferiors, and vast superiors, I were to see them yawning, looking at the clock, and fiddling with their cell phones? I'm not sure how well I could have dealt with the situation if such had been the case. I don't know if I would have burst into tears or if I would have walked out of the lecture hall with no explanation and without excusing myself. 

Fortunately, my worst-case scenario never came to fruition. I don't know if the underclassmen had been warned that their cell phones were not to be in sight and that they must be an attentive audience, or if I was simply seeing the humanity of everyone present, but it was as though almost everyone there -- especially the youngest audience members -- was on the edge of their seats from the moment I began to speak. My dad had learned from some unknown source -- I didn't tell him, nor did I even tell Matthew -- that I was to serve as a guest lecturer. He asked if he could attend, which was very kind of him, as he could have simply shown up unannounced. I assume he wanted to be there as a source of support to me rather than because he wanted to hear what I would say. I respectfully asked him not to come. His presence would have made the task even more daunting to me. I was then surprised to see my psychiatrist, otherwise known in previous blog postings as Chairman Mao, slip in the door and into one of the few remaining seats just after I had begun to speak. He held up a pre-made sign on a 12" by 18" paper. It read simply, "I'm here if you need me." He knows my story as well as I know it, and could have taken over for me at any time had I needed him to do so. If he had asked for permission to attend, I would have, as I did with my dad, respectfully declined his invitation. Seeing him, though, and knowing that he was available if I needed assistance bolstered my confidence.

I was told that my presentation, with a brief interval for questions at the conclusion, should  take an hour. From the first word I spoke until the final question had been answered (there were students whose questions I did not get to; four stayed to ask me privately afterward) I took exactly sixty minutes. I only began to lose composure when discussing the most painful and graphic aspects of the restroom attack, and the indignity of needing to be connected to a bladder catheter for eight days following the attack. Chairman Mao appeared prepared to rise from his seat, but I smiled at him through my tears and told him I was OK. I dabbed at my eyes with a tissue from a box someone had thoughtfully placed on the lectern, took a sip of water from the bottle left there for me, and continued.  It wasn't fun to talk about it, just as it isn't pleasant even to think about it, but it's possible that each time I tell the story, it has less power over me -- less of something to for me to hide, and less of something to fear in my mind when I hear myself speak the words aloud. 

Interestingly, this is in contrast to what I was told by a local practitioner before I began treatment at the inpatient facility. She said that talking about it other than to her in therapy sessions would only cause me to relive the incident repeatedly. Perhaps what she said is true in some instances and for some people, but it hasn't been the case for me. It's not as though I want to go on the lecture circuit and tell my story every day, or even to relive it in casual conversations among acquaintances, but sharing it at times when it has felt right to do so has been therapeutic for me. I'm very grateful to have been under the care of the particular local therapist only for the brief time that I saw her. 


I called attention to the presence of Chairman Mao, my true savior in all of this. Many family members wanted to help and did so in their own ways, but Chairman Mao was tho one who possessed the knowledge and skills to enable me to begin putting the traumatic events past me. I asked him to stand, and we all applauded him. He bears more responsibility than anyone else for my progress in overcoming the lingering trauma from a set of unfortunate events that happened a little too closely together for me to bounce back from them easily and  on my own.  It was at this point that I shared stories of the fun times we were allowed to have in the in-patient facility, many instigated by us, the patients, and not by his rather lame "activity director," but how he went along with anything that seemed harmless. I expressed that it was a relief to know that many of the patients were not significantly "crazier" than I was; they were merely young people with issues; many of them suffered from lingering effects of PTSD just as I did. I told the story once again of deliberately dislocating my arm to avoid a confrontation with him, and how successful my ploy was. I then had to demonstrate my ability to dislocate both of my arms at the elbow, then put them back into place myself. My audience was impressed. if medicine doesn't work for me, the circus might.There are probably other joints i could dislocated if I put any real effort into it.

I felt that I did what was expected of me by the professor who asked me to speak. He wanted equal emphasis upon the events themselves and the subsequent treatment. While my audience was wonderfully and respectfully attentive throughout the presentation, their questions focused far more on the events than upon the treatment. They were understandably interested in the primary attacker, in his sentence, and in his current whereabouts.  I suspect the professor was disappointed that their questions were not more focused on the treatment, but they're human, and they wanted to know whatever it was they wanted to know.

The professor asked if I would consider presenting again in the future.  I told him that I didn't want to do it again very soon, but if he were to ask me again in a year or so, I would seriously consider speaking again. Meanwhile, I'm $500.00 wealthier for my effort.  Our cohort, or those of us who are off-duty,  will be having a beach party this weekend. I'll be generous with provisions and libations.  

As for me, I feel that I've metaphorically thrown a gorilla from my back.  I don't know who among my peers and superiors knew of my past -- it wasn't a total secret -- but now it's all out in the open. Anyone around here with whom I work who didn't know already either does now or will soon.  I no longer really need to worry about it. I hope no one will treat me differently as a result of their newly acquired knowledge of me, but if they do, the effect will be temporary. I'll return to being Cutthroat Bitch soon enough.

One More Day in Outpatient Pediatrics

Tomorrow I will wrap up the outpatient portion of my pediatrics rotation. I have two more weeks of the pediatrics rotation. I'll be in pediatric E.R. next week, partly at the children's hospital and partly at a general university hospital, where pediatric cases still end up. I'm not especially apprehensive because, unless there's some sort of catastrophic event such as a major earthquake or collapse of a bridge or both, in which case sometimes even such employees  as custodians and receptionists function as medical personnel by necessity,  I won't be expected to manage anything especially grave by myself.  I may have the opportunity to stitch, staple, or glue boo boos, and now that I've done it before, I may be asked to remove foreign objects from noses or ears. If inserting IVs is necessary, that, too, is something I can do with ease. We're only rarely expected to draw blood -- usually in cases in which a child's veins are so tiny that a phlebotomist cannot find a vein -- but it's usually a registered nurse who takes over in such instances. Because I'm relatively skilled, I could be called into service should it be necessary. It's easier to draw blood than it is to insert an IV, anyway, and it's less painful to the patient.


I will then finish up my pediatric rotation with a week of pediatric oncology and hematology. I cannot say that it is something to which I'm looking forward. I won't complain if my dad decides to be here next week. I won't mind having him with me the first time I have to work on the pediatric oncology floor. (It's interesting that I don't mind having my dad around the hospital, but Matthew doesn't want him anywhere near when he's working and would prefer not to acknowledge that he's even related to my dad except that the physical resemblance is so strong that a denial would be an obvious lie.)We supposedly spend as more time interacting with and entertaining the pediatric oncology patients as we do performing  procedures on them. We do assess them, and we  observe a fair number of procedures. The idea is that these babies have been through so much already in their short lives without inflicting upon them the added burden of being turned into medical students' crash-test dummies. It's the only humane way of handling the situation.  Still, the prospect makes me very nervous.

The outpatient portion of pediatrics has been my favorite sub=rotation of my thus far short clerkship. That doesn't mean I'm seriously looking at pursuing pediatrics as a specialty. i'm not. It just means I've worked with people who are nice and fun. Because my Step 1 score on the USMLE was almost insanely high, I could probably choose almost anything as my subinternship yet not be adversely affected in terms of obtaining a desired match for my internship and residency. Applying for a pediatrics sub-internship is not out of the question. Then again, perhaps i'll like the next specialty even more.

A Very Silly Post Related to John F. Kennedy, Junior

What girl in her right mind wouldn't imagine herself married to this super-hunk?

I was born in the wrong time and place. A whole lot of people think that about themselves, but i think I have substance to back up my claims. Humor me for just a moment, please, and allow me to plead my case.

I'm not actually complaining so much about the era of my birth and life as I am complaining about the lack of synchronicity between my life and that of the late John F. Kennedy, Jr. The two of us would have been a fabulous couple, with the exception of the minor discrepancy of physical appearance. On a rating scale, JFK Jr. was clearly a perfect 10, while I'm closer to a 6.5 on a good day.

JFK Jr. had a perfectly decent wife in Carolyn Bessette Kennedy, and she had the stunning looks to go along with the Greek-God-like appearance of JFK Jr.  There were signs, however, that she was cracking under the strain of being married to the world's most gorgeous man. I don't think his looks were the problem.  The problem was more of the constant public scrutiny and the pursuit of paparazzi. It's something I believe i could have withstood, though we'll never know that for certain, because, barring my being an unwitting witness in a sensational media-frenzy-fueled crime, i will never be subjected to being hounded by the press. 

For the moment, let us forget about Carolyn Bessette Kennedy. I do not intend that to be disrespectful or disparaging in any way. It's just that she's not germane in any way to the points I'm intending to make. I'm not out to convince anyone that I am superior to the person she was in any way, because I'm not. She was a lovely, intelligent, charming person. My point is merely that had I come along before she and had I somehow convinced JFK Jr. and his family (while no one in the family other than the man himself had the final say, I'd venture a guess that they were not shy in voicing their opinions, and that he listened and considered their opinions at some level) that I wasn't a wholly unsuitable fit to be conjoined legally with America's royal family, the union might possibly have worked.

There would have been a few obvious factors working against us, with an obvious socioeconomic gap between our families being an especially salient distinction. While a few of the Robert F. Kennedy offspring married into the solid middle class, it wasn't something either John or Caroline was likely to do. It wasn't even wealth per se as much as lifestyle. I suspect a Tier One Kennedy would be or would have been perfectly compatible with someone who came from a family of old wealth whose family somehow managed not to hang onto their money. 

My parents aren't poor; how wealthy they are, I don't know, but I do know that they could choose never to work another day in their lives and would have the means to maintain a much more extravagant lifestyle than they've maintained thus far. Still, if my parents are wealthy, and it's probably a stretch to say that they are wealthy  -- they're probably more likely firmly entrenched in America's upper middle class -- they're nouveau riche. While my paternal grandparents possibly have the wealth to place them in the upper-class, speaking strictly of finances, as we know it takes more than money to propel a person to the bona fide upper class,  my grandfather's major windfall occurred after my father was on his own. Nothing my parents ever earned was as a result of a start-up fund from my grandparents. My dad didn't sell off stock to pay his college expenses; he had no stock to sell.  What undergraduate tuition and expenses were not covered by academic scholarship money - and most of them were - my father paid back to his parents.   My grandparents didn't contribute a cent to my father's medical school costs or living costs while in med school. 

Speaking of lifestyles of the jet set, I've left the American continent three times: twice to travel to Hawaii and once to visit Ireland. My parents are world travelers, but they've traveled the world without us. Their plan was to provide us with sufficiently substantial educations that we would have the ability to earn the money to travel to anywhere one can travel. We have  traveled, but on the North American continent. The majority of our trips were to visit relatives in the Utah-Idaho region, and in the neighboring states so that we could hit major tourist attractions while on those trips to visit relatives. We have hit both the northern and southern regions of the east coast as well. I don't wish to paint a picture of my parents plopping us in dismal central California and allowing us to rot. On the other hand, JFK Jr. probably spent as much time in airplanes as a child as I spent in automobiles. We grew up in different worlds.

On the other hand, I'm an adaptable person.  If someone wanted to place me in a situation where my vacations were limited only by time and not by means, I could live with that.  If I had to exist in a situation where paid help prepared most of the meals, cleared the dishes from the table, and handled the rest of the clean-up chores. that, too, would be within my scope of coping mechanisms. If I lived in a pristine home in which I didn't even know where the vacuum cleaner was kept, I wouldn't lose a great deal of sleep in worrying about the location of the vacuum cleaner or any other cleaning supplies.  I might not even bother to look for them unless a child tossed his or her cookies on a day when the hired help was off.  I could  go with the flow where those things were concerned.

I would have completed  medical school and the shortest possible residency.  I would have affiliated myself with some medical facility in the vicinity of the residence JFK Jr.chose. If I woke up and it seemed like a nice day to practice medicine, I would have shown up. If, on the other hand, I looked out the window, saw the snow softly coming down, and decided that it was more a doughnuts-and-hot-chocolate-while-reading-or-watching-garbage-TV-or-playing-the-piano sort of day, I would simply have placed a call to the medical facility to let them know I would be unavailable for the day barring a major subway crash or disaster of epic 9/11 proportions. It's a lifestyle to which I could have grown accustomed.

The downside of public scrutiny and paparazzi is something with which I could have dealt. The tabloid headlines of "JFK JR. is to ditch Plain Jane Wife for Italian Supermodel" might have been a bit cumbersome, but overlooking such things is an acquired skill. I could have smiled and waved at the paparazzi each time I left my apartment. I wouldn't have felt the need to make enemies of them. I'm secure enough in who I am not to be worried about a few unfavorable photographs hitting the tabloids. Furthermore, I've spent most of my life competing with a sibling for attention. A bit of free attention tossed in my direction is not something that would have caused me undue stress.

A bit of strategically applied cosmetic surgery (not of the Michael Jackson variety; I'd still look like myself, but just a bit prettier) might have downplayed some of the headlines lamenting the discrepancy between our appearances. Beyond that, I'm comfortable with my girl-next-door appearance, if JFK jR.could have grown accustomed to it. After years of dating Hollywood starlets and the like, it would have been a step down in the department of aesthetics. (It probably would have been a step up in the intellectual department, though.) I'm never going to be the prettiest girl in a room, but I'll not usually be the ugliest one, either.  And, when you get down to it, looks are highly superficial.

Height may have been a bit of an issue. I believe JFK Jr. was something like 6'3". I'm 5'3". Some people think tall men look "cute" with shorter women. Those people are a minority. I would have needed serious tutoring in walking in stilettos until I had perfected the art. The discrepancy in heights would then have been minimized, though never eliminated. I suppose I would have to tried to stand on a higher step for better photo opportunities.

Monogamy may possibly have been an issue, though I never read of rumors of dalliance once JFK Jr. was married. I know there were cases of marital infidelity among some of JFK Jr.'s cousins, but nothing that would compare with what was reported of their fathers. The genetic or learned behavioral tendency in that regard seems to have been diluted in the next generation. It's possible they don't even exceed the national average in that regard. Some of my professors and supervising physicians exhibit the same behaviors and none of them, to the best of my knowledge, are in any way related to the Kennedys.

It's a moot point. JFK, JR. was born in 1960, which is years before even my parents were born, while I came into this world in late 1994. It was never meant to be. Still, it's fun once in awhile to imagine how things might have been.