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.

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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.

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.