This Room is Dark

How much time is spent in a room, spine bent in attentive position, reading, writing, and unbending to sleep? Or what do you make of the things on your daily to-do list, written in earnestness, but failed from procrastination? What drama pervades everyday life more exciting than an unexpected e-mail, unveiling new possibilities – “now I must respond decisively, proving my worth.”

Much daily work is performed in a hip-flexed posture, sitting stationary but restless. Exercise is scrawled on the to-do list but gets passed over for the comfort of bed – an easygoing old friend – and a movie or two. Every few seconds to minutes, a notification pops up, and the attention wanders: GrubHub – More blocks available for Today. Piqued, I think: “Why not? I’ll go for a ride.”

Two orders in, 13 dollars and 25 dollars (good), another comes up for 13. I accept. On closer inspection, it’s actually split into two orders from one place, an ice cream shop. In examining each order, one of them is to be delivered to a wealthy apartment building, and somehow the tip on that order amounts to zero (total ~4 dollars; so the other is 9).

(In the GrubHub customer app or website, tipping zero is a willful, non-default action.)

I decide to test the waters on this one. On arriving at the magnificent building, with its prodigious shadow sprawling over contiguous sea, I spot no legal parking spots nearby, so I call the customer and ask her to come down. Peeved, she rebuffs my gentle-natured pleas for compassion (“I would hate to get a parking ticket,” and so on) “Do your job and bring it up,” she says. “Certainly, ma’am.” Conflict is to be eschewed at any cost, especially with situations so petty.

I approach the doorman – a handsome, young black man – tell him the room number, and he laughs. It appears he has some experience with said occupants, a lady and her gentleman caller. At wit’s end, having bowed before the supreme Goddess (initials EM) who evidently views GrubHub drivers as far beneath her ilk, I take the shiny elevator up and knock on the door. A man answers and snatches the food from my grasp as I recite a pre-rehearsed “Thank you for your extreme generosity.” The man makes no eye contact. He barely twitches his stolid facial expression and slothlike frame upon slowly processing my pointed remark. His mouth position is fixed like the agape maw of a tired, hungry dog, and on securing the ice cream he slams the door shut. I walk back to the elevator, proud to have said what I did in as respectful a manner as possible; then, hesitate. “Maybe I should have just let it go.”

I descend back to sea level on the modern, swift elevator, and while nearing the exit, I approach the doorman again: “Let me ask you an honest question: Have you had any odd or uncomfortable experiences with the occupants of room 1xyz?” He laughs again, as he did when I first entered this opulent palace, pauses to formulate an answer, then decides to dole out the unvarnished truth:

“They’ve got a ton of green, and they’re ornery as fuck.” “Hmm,” I say, “that makes sense. They tipped me zero dollars and treated me badly.” “Yup. That’s the way they are. Trust me, you’re not the first one.” Satisfied with his confirmation, I bid him a good night and run back to my illegally parked car, check for any tickets slapped onto the windshield (none), and navigate back to home.

It is here that I can reflect on what happened. I detail the events to my mother, and she assures me that I’m bound to meet all sorts of people with varying personal ethics. I want to hear more, something critical or damning. She doesn’t give in. My pit bull, laying next to mom, displays higher ethical standards than that supremely wealthy couple living in a wholly different world than ours, high up in their sumptuous castle, barely deigning to look upon such unwashed plebeians as myself.

The ego hurts, but it’s pointless. I’ve been told at various times to empathize with those who hurt you, and try to understand what drives them. Everyone has problems. At the end of today, I’ve come across many more generous people than unkind, yet the one negative experience shrouds the rest in complete cognitive domination. I should be grateful, and now that I say it, seated comfortably on the bed of my dark room, I am.

@DoctorGrubHub

Memory Ramblings

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As a child wandering the globe, I brought along a healthy dose of Soviet skepticism. Upon exiting Russia and arriving in the UK at London’s Heathrow Airport, I looked around at the Brits and asked “What are all these foreigners doing here?” My parents laughed, finding it ‘cute.’

In order to acclimate, I read various books handed to me by my parents, and first among these was a general encyclopedia, written in English, of course. Daily I scanned numerous entries with an insatiable drive to understand, while at school the only words I dared utter to my young British peers were “let’s go play” (It was the first grade, with plenty of recess built into the curriculum).

Unbeknownst to me or my peers, an intricate set of neural processes allowing accelerated learning and memory formation were underway in my ripening 7 year-old brain, and they were made possible by an ancient, highly-evolved need to survive. During sleep, I was terrorized by the recurring nightmare of coming to school naked, sitting in the front row, and unable to escape. Upon waking, there was only partial relief, as I would still have to navigate the day nakedly ignorant of English and dimly repeating that tired phrase: “let’s go play.” The young Brits must have found me an odd fellow. I could barely speak, though I downright thrashed the rest of the class in the Maths (as I write, I think: “What an odd thing to boast about decades later: performance in elementary school math. Who cares?” But then we all need some memories of triumph to boost the spirits from time to time.)

The pattern of my life in England went on in such manner for a little while longer – naked nightmares in sleep, semi-mutism at school, and hurried study of dictionaries and encyclopedias at home – until one day, I arrived at school and suddenly spoke fluent, accent-less English with my British peers, who had surely tolerated my one-phrase trick, “let’s go play,” more than it deserved. Without notice, one or two months after setting foot in this country of foreigners, I became one of them, acquired a best friend or two, and went about my days as if I were residing in my country of birth. A similar, sudden transformation would occur several years later when my family moved to Germany.

I look back with wonderment at what a child’s brain is capable of – what humans are capable of. Our family moved from one place to another, and a strong survival mechanism kicked in every time, allowing me to master the language and mold my temperament to fit the presiding culture. As a child, I was naturally ignorant of the astounding neural plasticity involved in such feats.

Long-Term Potentiation in Learning and Memory, Queensland Brain Institute

Books played a pivotal role in my recurring acclimitization. When we arrived in America, I studied the encyclopedias, as usual, and got hung up with one entry in particular: Elvis Presley. For some reason, I considered him a hero despite rarely listening to his hits, and every time I re-read his entry, a profound sadness welled over when the entry desribed his untimely death.

Elvis helped introduce me to human fallibility and mortality, and I pondered the unanswerable questions of life: What good is it for humanity to lose one of its great men at so tender an age? As a teenager I would ask similar questions about the fates of Jimi Hendrix, Bruce Lee, Kurt Cobain, Nick Drake, and, especially, Stevie Ray Vaughn. Is there a purpose to this, or isn’t there?

One can easily enumerate a list of great figures who died prematurely, and lately I have been stuck on the late Christopher Hitchens, a journalist and author of inimitable wit coupled with an encyclopaedic knowledge of history and great literature. In debates, he was infamous for dispensing mercilessly with his enemies, usually authoritarian types, while sipping on strong drink and smoking cigarettes, both of which almost certainly contributed to his death from esophageal cancer.

Christopher’s father had also died from esophageal cancer and similarly overindulged in alcohol and tobacco consumption. Knowing this, Christopher Hitchens stubbornly refused to deviate – the parties at his D.C. home were notorious escapes attended by intellectual elites, soaked in unimpeded revelry.

Among the many undertakings throughout his illustrious career, Christopher Hitchens wrote God is Not Great: How Religion Poisons Everything, and embarked on a series of debates with various evangelical Christian, Roman Catholic, Orthodox Jewish, and Muslim faith leaders. In each one, he dispatched his opponents with considerable ease and the usual ascerbic wit. So as he lay dying of esophageal cancer, he described receiving a variety of mail from religious people: spiteful damnations to an imminent eternity of hell as well as prayers for his convalescence. After his passing, everyone who knew of him pondered the same question: Did Christopher Hitchens succumb to hypocrisy in praying to God for salvation on his deathbed? Surely, it would have been forgivable, given his embattled, tumor-ridden state.

Nobody will ever know. With the untimely passing of each precious life, full of potential, we are haunted with the questions of purpose and meaning.

In my own life, I’ve often pondered the meaning of events: those that saw my family leave the Soviet Union, my dedication to medicine, an untimely derailment from a profession I loved, and recently, my unlikely return to a well-regarded Surgical residency. Did all of this have to happen? These are unanswerable questions, even from a strictly deterministic perspective.

Ernest Hemingway’s well-worn quote about such matters was that “the world breaks everyone and afterward many are strong at the broken places.” Considering his self-inflicted demise, even he didn’t believe that. The best we can do when looking back at specific moments in the past, such as finding oneself in a country of foreigners or losing something you love, is to accept that no other version of events would have been possible at the time. Ruthlessly, time moves along as it must, without regard for feelings or hopes.

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Goodbye to New York Style Cheesecake

I am a cheesecake. Or rather, I have become one. Of course, I’m not actually a cheesecake, but my organ systems are now thoroughly suffused in cheesecake. For the last 6 weeks, I have been on what can only be labeled a ‘cheesecake diet.’ Let me describe it in further detail, for those interested in trying it themselves (don’t). Before I do, I will note that my body weight has remained stably at ~190# despite a change in my overall intake from ‘healthy’ to ‘dessert-based.’ At 6’1″, this amounts to a body mass index (BMI) of 25.2, shyly breeching into the ‘overweight’ category. I’m slighly uncertain about this designation. Should I feel insecure? Of course, BMI does not distinguish lean from fat mass, but let’s stay on task. Here’s the diet:

1. Morning

Coffee (!) with milk and 2 sugars, 16-24 ounces; total caffeine content ~250mg
Dannon Greek Yogurt * 1 (80 kcal)

2. Afternoon

Small piece of chicken
Small salad, no dressing
Possible small coffee, ~100-150mg caffeine

3. Evening: nothing

4. Before bed: Fun begins

3-5 (average 4) slices of Carmine’s New York Style Cheesecake, 330 kcal per slice
1 full Ghirardelli Dark Chocolate Hazelnut (or similar) bar, 600 kcal
Sleep within 30 minutes of ingestion

That’s it! As you can see, I have managed to allow myself nightly cheesecake splurges by maintaining a very low daytime intake. Regarding activity levels, I have been largely sedentary in the past 6 weeks, with lots of sitting in the car or reading/writing in bed.

The diet and lifestyle combination thus outlined should not be undertaken, and my (poor) excuse for it has been ongoing right knee issues – mild lateral meniscus pain that went away, followed by a touch of patellofemoral pain. I chose not to run, and on starting up again a few days ago, my legs felt heavy and thick like cheesecake. The doughy heart protested, beating wildly at 190 per minute while I maintained a pedestrian easy pace of 9 min/mile. A simple jog, previously a respite from life’s dissatisfactions, became a source of dissatisfaction itself.

Now my concerns have increased to include poor fitness. I went to the track the other day to do 20 100 meter strides (not speedy, just smooth and steady), just to rekindle the neuromuscular coordination of proper running form, and again, my cheesecake legs staggered and jaunced during every rep with none of their prior smoothness. I thought about every stride and its component parts – stance phase, swing phase – and considering these made the motions more erratic. The more I thought, the more unruly it seemed. The reps weren’t physically taxing, given the light paces involved (15-17s / 100), but the hyper-awareness and doubt surrounding each movement disrupted the overall flow of the workout. Normally, it should be a flowing forward motion like a great egret gliding low over water looking for fish. In this case, much of my energy was wasted on excess ‘vertical oscillation.’ I bobbed up and down like a ravenous pigeon following an old lady’s breadcrumbs in Washington Square Park. Perhaps it’s the shoes, I wondered. This is a new pair of shoes – the Saucony Kinvara 9 – that I still haven’t quite synced up with. I had bought the Kinvaras after reading many positive reviews on sites like runrepeat.com, a trusty source on these matters. I felt betrayed. How could RunRepeat give these a 92 score, among the very best of the entire catalog? If RunRepeat can no longer be trusted, what and who else will let me down?

STOP.

None of this has to do with cheesecake, or chocolate, or running form, or running shoe websites. Below the surface of cheesecake and running lies the grumbling, ever-sated monster of fear. I’ve gotten the residency position, and I’ll be moving soon. Euphoria of returning to beloved profession mixes with uncertainty about where I will go after the year is up. It’s a prelim (1-year) surgery position. There is much fight ahead, and I do not possess infinite resources. I have limited time left on this planet; maybe 50 or 60 years, if all goes well. I have no children, though I think I’d be a great father. I want at least 2 – a boy and a girl – but I lack the stability and finances to afford the unique privilege of parenthood.

I am mortal, had been wounded, and, now that my life and mana are restored (Diablo), I feel the weight of humanity.

(Blurry gray fuzz takes me back to the Soviet Union, where an uncle of mine used to look upon my innocent 6-year-old physiognomy and say: “You have the travails of all the Jewish people written upon your face, the mask of tragedy.” Then he would smile endearingly and get me to cheer up. He lives in Israel now.)

As new life beckons ahead, I know exactly what I must do, so I bid goodbye to New York Style cheesecake with dark chocolate squares.

No, this isn’t about cheesecake at all. Not at all.

An Update to my Residency Search

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I left my dream residency in Plastic and Reconstructive Surgery a few years ago in ill health, and I did not, for the life of me, want to be a patient. So I procrastinated on seeking treatment. I had become used to being a physician who diligently and compassionately tended to the needs of his patients, but I did not initially have the guts to carry out what was necessary when my role was reversed to that of a patient. Away from Surgery, my life lacked purpose, and an abiding darkness overcame my being. The cruelty of life is the free choice we are given, as it can be harnessed responsibly for good or frittered wastefully into emptiness. The emptiness of my existence built on itself and eroded who I once was – physician, son, brother, athletics enthusiast, and so on. Nothing mattered anymore as I progressed into a learned helplessness. To pick up this laptop and write would have been a colossal undertaking. Sometimes, I would go for a 5-mile run, perform 60 meter sprints at the local track, or lift weights at the gym; but beneath it all I felt displaced.

Finally, in this past year things changed. I sought treatment, fulfilled my responsibilities, and worked up the moral courage to assert my true self – at the core, a physician who loves Medicine with all of his being. Humbly, I began making inroads into eradicating the destructive force that nihilism had wrought. I made small steps, the most important of which was to acquire work as a GrubHub driver. If I succeed in my life plans 10 years on, I will look back to GrubHub driving as a pivotal step. Always, there are loud voices in one’s head that shout fear, embarrassment, and paralysis. Exhausted, I did not care for those voices anymore. I drive for GrubHub serving others to the best of my ability.

Recently, I told a former business school classmate of mine about my slow return to purposeful personhood, and specifically that I drive for GrubHub. His response was: “Why are you working for GrubHub. You may as well sell your ass on the internet.” Instead of plunging into self-pity or defensiveness, I chose simply to brush his comment aside.

I’ve been applying to residency vacancies for a few months now, and I’ve gotten several interviews in various forms: on-site, video call, and phone calls. A couple of weeks ago, I got a call from a Surgery program director while I otherwise indisposed, and my faith in humanity grew stronger. After a long conversation, the program director offered me the position, and I took it.

I’ve been away from Medicine for a while, and this absence makes for a self-evident red flag for every application I send out. During interviews, it is necessarily the primary topic of discussion, and I found myself interviewing quite well despite this. Even so, programs had been unwilling to hire me. The loved ones in my life nudged me on after every rejection, saying “all it takes is one,” and because of them I did not relent.

In the end, they were correct. It took one unexpected phone call at an inopportune time for me to find myself back in the world of Surgery again. I could not possibly be more grateful to the program director, or to the supportive loved ones in my life, than I am now. Today, my biggest problems are filling out pre-employment paperwork, securing housing, and planning for the move.

I don’t have much GrubHub time remaining now, but I will continue to make the most of it, partly out of financial necessity, and partly out of gratitude to GrubHub for instilling in me a sense of purpose through work. It could have been any other work, like consulting, that fulfilled this purpose, but for me it was GrubHub.

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Taking Pictures and GrubHubbing

Sometimes I drive around with the GrubHub app on and feel the urge to snap a few pictures of the scenery.

I roam the city wide with the radio scratching its mystical fuzz as I scan the stations according to mood. Mine is an older car, without satellite radio or bluetooth connectivity, so the choices consist of AM and FM. I could play a cassette if so inclined; or set it to a hollow white noise synced to the electroencephalographic-equivalent beta waves of my unsettled brain. I’m being presumptuous: often while driving my brain activity, like tranquil beach waves coming and going, rests at a rhythmic, relaxing alpha pattern. And so it goes on, until I find NPR.

NPR can be a hit-or-miss. I enjoy their interviews and shows like This American Life, Radiolab, or the Moth Radio Hour. But when they cover controversial political issues, I recede into my shell like a startled turtle. Mostly, I eschew political coverage from any source, as it tends to bitterly divide people along hard, moral lines. Each side of a given issue views the other as irretrievably evil, without giving any benefit of the doubt. 15 years ago, I could read the New York Times, The Economist, or The Wall Street Journal and trust that the nuance of their reporting isn’t entirely geared towards swaying my opinions with psychological tricks of influence. Now, I’m not sure whom to trust if I want to get ‘just the facts.’ Most reporting seems to have become opinion pieces disguised as innocuous journalism. When discussion of politics comes up on the radio, I switch it off and pay closer attention to the road, the cars, the objects, and the people I pass. What a city! Occasionally, I pull over and snap a few photos for later remembrance. Here are just a few:

Man stops in the street to check his phone.

I start posting more to instagram. In the meantime, I’ve got a few more deliveries to make.

Ridiculous Residency Vacancies

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Every morning, I wake up, make coffee, and forage through the great thicket of the internet in search of residency vacancies. The internet or ‘web,’ as you know, expands continuously just as the universe, and with it arise visions of alternate realties somewhere pleasantly distant and unmoored in the daily rut of routine. Navigating it requires skill and experience and I admit to possessing neither. However, I’ve built a steady habit of scouring specific websites in my search for residencies. When I come upon a position I like, I deploy the residency application algorithm now updated into my brain’s latest software – it’s an app – and switch the ‘application mode’ tab to ‘on.’ Hereafter the process is automatic – CV, diploma, dean’s letter, transcript, and USMLE files are sent, along with a specifically crafted statement of interest. An e-mail is fashioned for each program director or coordinator with the attachment of aforementioned files, and once it is sent ‘application mode’ turns back to ‘off,’ idling my reeling brain into the honey-sweet hibernation of accomplishment. Muscles un-tense, the coffee cup is put down, and I turn my dawdling attention to my cat, who starts purring as she glimpses my smile. And thus the application cycle goes on and around for each vacancy that I spot.

However, of late I’ve woken up, chugged my coffee, and have noticed a stream of ridiculous residency vacancy postings online. As a reminder, the sites I use include inforesidency, residentswap, program directors in surgery, and SDN, among others. Several ads offer UNPAID positions to CURRENT RESIDENTS. See below for examples.

The gall of this posting consists in the program’s desire to “recruit an exceptional general surgery resident” (read: someone already in clinical residency receiving a salary) for a “minimum commitment of one year” of research work in a “non-paid, full-time volunteer position.” I don’t seek to single this posting out in particular, as I’ve run into multiple others like it, but the main, overarching issue with these kinds of job ads is they are recruiting slave labor. The underlying message implicit in these postings is “if you put in your indentured servitude, you MAY have a chance at a shot somewhere, maybe even with us.”

This brings up another point: Who but the independently wealthy can afford such a digression in their surgical careers for the sake of bettering one’s CV? Further, who but the independently wealthy can lead reasonably-accomodated lives while performing residencies or fellowships in cost-prohibitive areas like Manhattan, Los Angeles or the Bay Area? In such places, the system of resident selection authomatically benefits those with means and preferred insiders at the expense of a bona fide meritocracy. There have even been plenty of programs where Faculty persons have selected their own progeny as residents! Absurd examples aside, it is important to note that Medicine and its specialties contain rigid borders to keep out the rabble from their hallowed inner circles of accumulated power and self-aggrandizement.

In short, if you lack the financial means, do not apply.

Notes on a recent Interview

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Out of sheer luck, I have had a few interviews over the past couple of months ranging from video calls to the formality of on-site visits. I apply broadly within the large domain of surgery and its subspecialties, as “beggars can’t be choosers,” an oft-repeated phrase I utter like a mantra in times of insecurity about my current station in life. The most recent of interviews took place on-site at a University medical center. Six of us were selected to vie for a PGY-1 vacancy for a subspecialty surgical position, wherein the previously matched applicant had decided that surgery was not right for him. (This was a wise choice, as Surgery demands everything, will take your blood and soul, and if you harbor any doubts, then consider all your questions answered. Perhaps I’m being overly dramatic, but I’ve heard this said by other surgeons throughout my education and training and am merely repeating the gist of what they said.)

I drove 5 hours on a cold gray morning, and a mild but irritating snowfall hailed my arrival at the large rotunda of the Medical Center. As a Soviet emigre, I love the snow – it is within me – but I found its timing inopportune. I rushed into the closest bathroom to get changed and found I had forgotten my black dress shoes in the car, so the resultant figure exiting the bathroom was one donning a black suit, navy tie, and punctuated with the discordant touch of light blue-and-yellow Mizuno running sneakers. It could just as easily have been an outfit for a costumed 5k race as for a life-determining interview. I rushed back to the car, exchanged the shoes, and navigated to the Meeting Place, hitherto established by the residency program manager. She greeted applicants and took us to the Department’s Conference Room.

For Residency, the Conference Room is a place unto itself. It takes many forms – dingy, modern, high-tech, mahogany-clad, and so on. The Conference Room of a Department may demand no particular aesthetic appreciation, resemble an Ikea layout, or look like every other mass-produced room throughout the Medical Center, with sturdy yet unimaginative furniture, but it contains within its hallowed walls the inimitable product of a program’s history, rife with discovery, learning, teaching, planning, argument, and, not least, political drama. A Surgical Department or Division is like a large well-to-do family, with all the requisite in-fighting and machinations that characterize the likes of Rockefellers or the DuPonts. Of course, there is also ample love and mutual respect. Each program is unique in the degree to which collegiality trumps the less mannered manifestations of our natures.

As I sat with my co-interviewees in a comfortable leather chair and observed the program throughout the day, this one in particular struck me as quite genuinely collegial. The faculty treated residents with the respect of a junior colleague, and lightheartedness abounded, when appropriate.

Each candidate interviewed with 4 members of the faculty, including the Chief and Program Director. This is fairly standard. The candidates were diverse and ranged in the breadth and nature of their experiences. I felt at ease with them, and hopefully they with me. My interviews proceeded in a standard fashion, more or less, excepting one, wherein the interviewer appeared to conduct an ‘Emotional Intelligence’ interview with hypothetical scenarios of workplace situations. I found this interesting and unique, and it enamored me to the place even more. The other interviews asked me to expound on my background and fill in the gap in my CV. This was done in a non-intrusive way, and I felt at ease disclosing things with nothing but the utmost honesty. We also had a few chances to interact with current residents, as time permitted. They were friendly, intelligent, hardworking, and honest.

In the end, I finished with my last interview, and the program coordinator kindly gave me directions to the garage. I got into the car, took off my jacket, tie, and dress shirt; changed my shoes, and headed for the highway in what would be a tedious and pensive drive to Home. On arriving, I cut two slices of cheesecake, boiled hot water for a cup of passionfruit jasmine green tea, and broke off four squares of Ghirardelli Intense Dark Hazenut Heaven chocolates, all in preparation for a long day of GrubHubbing the next day.

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What I am doing to return to Medicine and Surgery

I’ve been away from Medicine and Surgery for a couple of years, addressing health issues, for the most part. Now that my health is restored, I view the world with renewed optimism and am itching to return to my first love, practicing as a physician. I had completed two years of a surgical subspecialty residency which I enjoyed immensely before taking an indefinite medical leave, and eventually my time for returning to the position expired.

My approach to The Return has been twofold:

Stay busy with work – i.e. GrubHub – as well as fitness, running, and reading for pleasure. Also, when I read, I’m astounded by the gaps in my fund of general knowledge about the world and seek always to remedy it, only to find the gaps expand the more I read.
Monitor residency vacancies through several online platforms, including inforesidency, ResidentSwap, FindAResident by AAMC, StudentDoctorNetwork, and a few other specialized sites.

This approach has yielded little as of yet, and I suspect this is largely due to my prolonged absence from the clinical setting as a resident. As a Program Director, I would view any such candidate with more than a passing suspicion, and the questions about him would come naturally: Why was he gone for so long? Is he ready to return? Is he a LIABILITY? As physicians, we are (unfortunately) bred to consider potential liabilities in all of our daily decision-making for a variety of reasons. In the back of a typical physician’s mind during every interaction looms the veiled giant monster of a Lawsuit.

On an unrelated note, prevention of lawsuit is a large but hard to quantify contributor to the rising cost of modern healthcare. Countless CT scans have been performed with the implicit, often subconscious, notion to prevent a lawsuit for missing a diagnosis. Because we cannot scan the thoughts of the ordering physicians, it is impossible to tell how many needless tests were ordered on at least partially such a basis. In any case, I’m rambling thus merely to try and scan the brains of program directors viewing my CV and deciding whether to drop it into the virtual recycling bin or not.

Thus far, most programs I’ve applied to (eg. Preliminary Surgery) have chosen not to pursue me as I do them, and few have bothered to even write “We had many outstanding applicants…Unfortunately, we are unable to…wishing you the best in your future endeavors,” or some such euphemistic platitude. I don’t know what’s worse, receiving a concrete letter of rejection or floating in the purgatory of a non-response.

Even so, I’ve received a few interviews from nice programs, and I will write about them in the coming posts. In the meantime, I have a scheduled GrubHub session to prepare for. I will stay hungry.

Memorable Movies: Garden State

Large: I’ve been having these really intense headaches. They only last for a split second and then they’re gone. It’s like a lightning flash; almost like a surge of electricity and then it’s gone.

Doctor: You’re Gideon’s kid. I didn’t even put the two together.

Large: Yeah.

Doctor: I’m sorry about your mother.

Large: Yeah. Thank you.

Doctor: I must have missed you at Shiva last night.

Large: Yeah.

Doctor: So how long have these headaches been going on?

Large: Well I think I’ve had them in some form since I was a little kid. But they’ve been getting more and more frequent over the last year.

Doctor: (looking at chart) How long have you been on Lithium?

Large: Oh uh, I’ve been on some form of it since I was ten or so.

Doctor: And what about Paxil, Zoloft, Celexa, Depakote; did any of that ever help you?

Large: No. I mean I don’t know. It’s recently occurred to me that I might not even have a problem. Only I’d never know it, because as far back as I can remember I’ve been medicated. I grew up on it. I left them in LA. This is the first time I haven’t had it in my body since I can remember.

Doctor: Well, it’ll leave your body pretty fast. I’ll write you a prescription.

Large: Actually I…was thinking about taking a little vacation.

source: https://www.imsdb.com/scripts/Garden-State.html

As a bumbling undergraduate in the heart of New York City, I sauntered alone and contemplative through the streets during deserted Sunday mornings with a Starbucks mocha in my hand, sometimes bumming a cigarette from the occasional passerby and sitting on a bench at Union Square Park. In peak physical shape, I sipped the brown stuff and followed it with a long, wistful drag, and as the toxins flushed into my alveolar capillaries, I felt a profound loneliness admixed with a solace of hope.

I was an odd fellow. At nights, I’d bring my guitar out and play full-throated Dylan in the dorm basement of University Hall then bring the show out into the park, where I’d overcome intense anxiety to perform a few songs in the Park. The guitar case was splayed out suggestively, and I’d earn a few bucks for my next cup of Starbucks Mocha. I became such a frequent customer of that particular establishment, on 10 Union Square East circa 15th street, that at times a kind barista would make it for me free of charge. She sensed something in me I didn’t; either an empty wallet or an impoverished soul.

I had no friends, something I talked about with Dr. Dinstein every 2 weeks or so. She gave me a good discount and offered specialized therapy that few psychiatrists perform nowadays, except for rich clientele. For 45 minutes, she’d combat mid-day fatigue with a restrained yawn and checking of the clock. Every time she did this, I wanted to make her like me more, become more interested, so from time to time I’d throw in some embellished stories to dilate her pupils, bringing her up to full attention again. Immediately, she’d rush to scribble into her notebook again, and my face quivered into a faint smile. It was a healthy exchange between two humans. I haven’t seen her for a long time now, though on one of our appointments I visited her sprawling Westchester County home, where she held some therapy sessions out of convenience. Driving away from the secluded neighborhood, I’d sit and daydream of a bright future while fighting panicked thoughts of embarrassment, fear, looking for love, and emptiness; the usual fare of a lonely, anxious 20 year-old male.

Just now, I lied. I did have friends; a female, to be precise, and through our friendship I inherited her other friends. This friend, let’s call her Emily, accepted me wholeheartedly for the intensely anxious, self-conscious, and peculiar guy I was; all despite my innumerable faux pas with her and her cohort. She wanted a relationship, but I cherished our friendship as it was, and, harsh as it was, I had no physical attraction towards her. She made me feel smart, accepted, delightfully quirky, and worthy of being liked.

But I could not take it to the next level. My roommate advised me to let go of her, for, as he put it, all friendships between men and women contain inherent sexual tension. I didn’t agree, so my friendship with Emily lasted for 3 years before the final breaking point, where she and her friends mounted a vigorous pressure campaign to submit me to the reality that I did in fact love her in all ways, Platonic and otherwise. Nota bene: from the original readings in Plato’s Symposium, the term ‘platonic’ (coined long after his death) as used to define relationships does not strictly mean something non-amorous, so its modern usage is largely incorrect. Plato churns in his grave on this account.

On one particular occasion during the pressure campaign, Emily’s male friend took me aside for a talk, and used phrases like “bro, you know you love her, and that you’re meant to be together” to try and convince me of the truth I had yet to accept. I didn’t say yes, but I feared losing the nice friendships I had built through her, so I didn’t say no. But it was a turning point, and finally I confronted Emily about it, cruelly dispelling any hope she might have had about our ensuing love-dating-nuptials, and so on. She wept, a heartbreaking sight, and returned the cruelty right back to me: “You are not fun or interesting, and I never cared so much about being friends with you as I did for being with you. You are weird and nobody will ever like you for who you are.” And that was it. We went our separate ways, and I was alone again.

Despite the strident conflict at the end, I cannot say our time together was misspent. For one, she introduced me to some great music and movies, Garden State chief among them. For years after our undoing, I watched the movie over and over again, for something about it always struck an aching chord. Andrew Large (played by Zack Braff) was alone, uncomfortable in his shoes, and branded as abnormal from an early age. He never quite fit in. He had a history of trauma in his life, though I can’t quite use that term so liberally for myself, fearing its overuse at the expense of genuine trauma victims. I moved around the world a lot as a kid and always felt displaced. Home was nowhere, and in some ways I still seek it. Upon freeing himself from the reins of medications, psychiatry, and his past, he found a similarly quirky and lovable mate in Sam, played by the beautiful and intelligent Natalie Portman. So there’s the nice ending there as well, something I’ve always sought in movies ever since my parents had me watch countless Holocaust documentaries as a child (rightfully so).

I’m no movie Nazi or critic, as it were, but Garden State hit me at a point in life when I was keenly susceptible, and its essential message still lingers today; although I still seek that nice ending through my own travails – finishing surgical residency, moving back to near my parents, practicing Medicine, and having children with my lovely wife.

An Introduction

This is a personal site about my journey – at times embattled, others triumphant – in Medicine, my genuine calling. ‘Calling’ might sound trite or overused, but Medicine, and specifically Surgery, has given transcendent purpose to my life. Upon graduation from medical school, we recited the Declaration of Geneva, a modern variant of the Hippocratic Oath, and I have internalized the principles therein so that they became inextricable from my core essence as a human being, so that they seep from my pores. The primacy of curiously, conscientiously, and compassionately serving patients as a physician remains my highest aim, and I intend to restore my position in Medicine by re-entering a residency and fulfilling that duty.

Right now, I work as as GrubHub delivery driver. I take pride in the work. It is honest work. I am intensely grateful to the GrubHub Corporation and its Founders for allowing me to do it. I was in residency once but left for health reasons. As I seek a return to the profession I love dearly, I have started to log the small struggles unique to my particular situation. This will be a place of respite for logging some of the ups and downs, as well as a place to discuss broader issues, such as hobbies – reading, running, fitness, and photography. Hopefully, it will be a place where honesty and humility abide, for I have learned through observation that these are rare and invaluable traits. That’s it, for now.