The further I progress in specializing in medicine, the more I realize how much my daily abilities deteriorate.

Take language, for example. Aside from the broken Spanish I acquire from my Hispanic patients, I rarely invoke English dictum beyond the eighth grade. Our vocabulary in the office is limited to a defined collection of complex medical terms strung together with linking verbs and qualifiers describing outcomes (hemorrhage, blindness, infection, inflammation). Outside of  the office, I’ve struggled to identify common objects like “spoon” and “basket” without using hand gestures.

Is this shift simply a result of natural selection (adaptation on steroids!)? French naturalist Jean Lamarck coined terms like “use” and “disuse” for adaptation spanning generations. Are professionals contributing to their own extinction by being good at their job?

It would be interesting to measure cortical function throughout the course of medical school. This could be followed with serial PET scans to localize metabolic activity in the brain. Areas that fail to sustain signal can be used to correlate with mapped cortical regions. Indeed, a spatial correlation in such an experiment would be damming to future physicians-to-be…

misc euphemisms, humor, life

It is difficult to find time to relax while in residency. For the ophthalmology resident, the time consumption of residency can be overwhelming, especially if your non-call days run from 7am-7pm (Sometimes 9:30pm). Many of our hobbies and pastimes are neglected in favor of more career-oriented activities.

I spoke with Drew Mays, an ophthalmologist at UAB, about the stresses of residency and a career. Drew won the Van Cliburn Amateur piano competition a few years ago while being program director of the UAB residency. He is tangible evidence that you can allocate time for your hobbies. To those of you who are unfamiliar with this venue, it consists of a gathering of would-be classical pianists who decided to pursue a career outside of music. Drew assured me that there will be a time after my training where I will find sufficient time to pursue my hobbies. He tells me that during residency, we have to prioritize our options to create the maximal ‘amount’ of happiness.

Not too profound advice, but it is indeed a fact that we lose sight of (no pun intended). The next time you feel lost in the midst of your training, think about Drew’s reassurance. It can help get you through the day.

misc hobbies, inspiration, life

One of the most painful aspects of clinic, at least where I work, is that nine out of ten patients I see daily do not speak English. While I feel that I’m reaching my limit at broadening my linguistic abilities, it is disheartening not to be able to communicate fully with your patients. I occasionally use the interpreter lines only when necessary, because it adds an insurmountable delay to the schedule that cannot possibly be regained. At times, even the interpreters have difficulty understanding a patient’s native tongue.

Today a patient came into emergency triage stating that she had lost vision suddenly in one eye a month ago, but only decided to come to the clinic today. She also denied ever being here in the clinic. To no surprise, we did not have any records of their encounters in the clinic either.

I spent the next hour toiling around to find an egregious cause for her vision loss, only to find non-specific drusen in her fundus. When my attending, who was fluent in Spanish, questioned the patient again, the story was relayed in a different manner than I gathered. She had GRADUAL vision loss over a month, and she also “lost” her glasses 20 days ago. Her chart also magically appeared underneath my progress note–I suppose one of the techs found it 4 hours later–and a workup of AMD  was suggested in her plan.

Lesson learned: you can’t win.

medicine life

I took a bunch of wine cases from a wine superstore to use as packing material. Wine boxes are great shipping containers; they pack a sturdy 32 lbs/sq in. cardboard. This comes with no surprise, since wine is heavy. The sides come with substantial padding that is great for packing electronic equipment.

However, apparently you cannot ship wine (or parcels in wine packaging) through UPS without a license. Doh! Fortunately the guy at the UPS Store was kind enough to repack my boxes in a discrete cardboard box for a nominal fee.

misc life

One of my initial concerns in location of residency training was the cost. A metropolitan area like New York City and San Francisco comes with a hefty cost of living price tag. Do I want to pay $800 a month for a 2 bedroom gated condominium with swimming pool and tennis courts in Augusta, Georgia, or $2000 a month for a closet in Manhattan? While you should probably focus more on the quality of program and location in residency training, an extra $1200 a month in savings can be applied to important use (like repaying loans).

In retrospect, the cost differential isn’t as significant as I initially thought; the salaries are usually somewhat proportional to cost of living. One of my friends training in Boston ended up with similar funds as I did, simply because he had a higher salary and did not have a car to maintain. He’s now moving to Los Angeles, which is a sprawling freeway wasteland with traditionally crappy resident salaries.

I gave the salary issue a more quantitative analysis, and indeed it holds true to a certain extent. Take, for instance, the medicine residency program at St. Luke’s-Roosevelt Medical Center in NYC. For 2009, the PGY-2 salary is $58,463.  A subsidized studio runs about $1,600/month near the hospital. Wilmer Eye Institute in Baltimore pays its PGY-2 residents $44,192. An apartment in Baltimore away from the ghetto will cost at least $1,000 a month. The nearly $14,000 annual salary difference in NYC ought to cover the extra housing costs and hefty city taxes. In addition, you’d have to maintain a car in Baltimore.

But wait, you’re comparing a Yugo to a Rolls-Royce! Indeed, higher profile academic centers will still draw residents despite being in a seedy location and offering a lousy benefits package. It actually depends on the city.  MEEI offers a PGY-2 salary of approximately $52,000. Doheny offers a PGY-2 salary of $48,000, but a PGY-3 receives an extra $5,000 annually.

Ultimately, the end result is negligible. Instead, you should ask yourself whether you can tolerate living in a cramped apartment instead of a suburban home with a yard. Can you handle living in Utah if you typically spend your Friday nights at the bar? Or can you handle waiting in line for hours in Central Park to play tennis (don’t forget to buy a public tennis pass, or you’ll be fined!)?

economy, misc life, money