An old fellow gifted education geek emailed me to say hello, and wrote this great piece on the awkwardness of learning the female pelvic exam. Great work, Jules !

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I’ve always thought of myself as a man of contrasts (okay, more like a guy of contrasts, because man is just too serious, or formal, or something). But contrasts, anyway. I compliment myself, if that’s at all possible.

What I mean to say is that I find that I tend to have interests and fascinations with the seemingly most polar of topics: I like both theatre and science, I’m an introvert and an extrovert. I love web design, coding, and being all alone, but I also love parties, dancing, and entertaining people.

This whole concept came to light yesterday, when we went over to the Palo Alto VA for a discussion on hospice care and death and dying. I could really see myself working in such a place-helping people to end their lives with peace, comfort, and dignity. The hospice wing is quiet, solemn, and looks out onto the nice green grass and trees of the hospital complex; there are two “family rooms” available for families to stay free of charge in the last days of their loved ones’ lives; the physicians there spoke eloquently about respect, dignity, cultural differences, and honoring those that had died. It really resonated with me as a way to really help provide for people when they need it most. What could be more frightening than dying with fear and anxiety?

On the other hand, only three days ago, I was in love with the ER. It was loud, hectic, busy, with all sorts of people and all sorts of injuries and diseases and conditions. It’s crowded, people are stuffed together. The exact opposite of the quiet, solemn hospice wing.

I’ve always been pulled in different directions in life-a teacher once told me the hardest decisions you have to make are often ones that end up closing doors, not opening them. If I only liked one little area-y’know, choosing between the heart and the lungs, for example-I feel like this would be a much easier set of decisions to make. I’m blessed and cursed all at the same time. I tend to just try lots of different experiences, pick one, and know that I was meant to be there anyway. It’s a weird predeterministic worldview, with a quasi-Fate influence. But it works for me.

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Such is the sinusoidal curve that is my mood.

I was on top of the world last night, after doing an incredible 8-hour emergency medicine shift, getting to assist a plastic surgeon repairing a couple big bike accident gashes, getting to put in two sutures on another case, getting a great IV draw with blood cultures, and thinking now that I either want to go into emergency medicine (look out, GruntDoc ) or maybe even trauma surgery or plastics.

I was even in a good mood 2 hours ago studying biochemistry of all things, starting to think that maybe, just maybe, I was starting to understand this crap. That maybe, just maybe , there was a reason I should know this stuff.

And now I’m just totally defeated. I’m 14 questions into a biochemistry 50-question series on Kaplan’s QBank (boards study questions), and I feel awful. I feel stupid, I feel frustrated, I feel hopeless. If there’s any reason that anyone other than pediatricians, OB-GYNs, and PICU/NICU specialists need to know the minutae of the glycogen storage disorders , I would really love to hear the argument. I understand needing to know that they exist, but knowing how each one presents, and the mutation associated with it is really bleeping ridiculous. I hate you, NBME . Hate hate hate you.

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Yesterday we interviewed a patient with PTSD . I wish I could say more, but what he told us brought tears to my eyes. I’ve lived a pretty damn happy existence. The stuff people walk around with in their heads and carry around on their shoulders is just amazing. Reminds you never to judge-you just never know what the person has gone through.

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If you want some anecdotal evidence about our health care system, just start reading this thread on Ask Metafilter . I was amazed at how many people responded that have had major bill problems with the ER, or have given false names.

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I watched Born Into Brothels a couple nights ago, and it made me think really hard about my life, my privelege, and all the opportunity that I’ve been afforded and always just taken for granted. It’s a documentary telling the stories of children of sex workers in the red light district of northern Calcutta. The filmmaker gives the children point and shoot cameras to document their lives.

They the children are incredibly stigmatized in Calcutta, even having difficulties being accepted to schools because their mothers are criminals. They live in crowded, dirty apartments, where the adults scream curses at each other and at the children, but they’re amazingly resilient and positive. Most of the girls know on some level that they too will eventually become sex workers, an admission that’s very hard to hear coming from a 10-yar old’s mouth.

Two parts especially moved me and brought tears to my eyes. The first was the realization that some of the children could be HIV+. It blew my stigma about who or what an HIV+ person is out of the water. Just the idea that these kids could be living with the virus, totally unknowingly, was really emotionally difficult. The other event involved a child named Avijit, who really had an innate gift with a camera. He took some really stunning photographs, and spoke incredibly maturely for such a young child.

Avijit had said that at some point he had wanted “to be a doctor,” and it really hit home. All the opportunity that I’ve had, and that Avijit will never have. When I think about complaining about not wanting to study for the boards, or my frustration with biochemistry, I have to remember that at least it’s available to me. At least, when I was Avijit’s age and said, I want to be a doctor, I got to have my dream come true.

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We recently started our psych coursework-our last official class-this week, and we watched a short, 3-minute clip of a schizophrenic man being interviewed about his day-to-day life. He was homeless and clearly delusional, asking his social worker to please put in a request for the man’s new eyeglasses frames not to have a transmitter placed inside them.

The man was clearly not sharing the same reality as the rest of us watching him. I had the inclination to smile-not to laugh, just smile-and saw many of my classmates reacting the same way. I don’t know what the smile’s really from: a defense mechanism on how to deal with someone that has totally lost touch with reality? Amusement? Humor?

And then I thought about the man a little deeper. How much suffering this disease has caused. Not only in his current mental state, constantly dealing with his anxiety and paranoia, but also all the suffering from his former self. The one that had goals and dreams as a kid. The one before his schizophrenia took all that from him.

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