In the Residency Bubble, Paralyzed by Neurotoxins

I’ve been busy as hell, but I LOVE what I’m doing right now – the patients, the diseases, the studying, the procedures, the variety, and the super smart colleagues with which I’m surrounding.  I am happy with my professional life, but the problem of balance still exists.  I knew it would, just didn’t think it’d still be to this extent.  I’m working way too much.  I hate that it’s not at all under my control, and usually also not completely predictable to me.  Still a huge improvement over my intern year hours, but definitely not ideal.  At least I wake up happy, enjoy my day, and come home happy.  It’s better than coming home depressed and defeated, dreading the next day, crying on my way to and from work.  When I think about it, intern year feels like it was SO long ago.  I’m SO glad to have that behind us.

Residency is such a strange experience.  It’s hard to fully explain it to people who aren’t in medicine because it truly is a subculture.  As a universality in residency, we are constantly thrown into situations for which we feel inadequately prepared…to a degree that is almost unsafe.  It’s about constantly pushing the envelope: that boundary between uncomfortable and unsafe, without getting too close to just uncomfortable but also staying just left of unsafe.  It’s a tightrope.  What it creates is a constant state of anxiety…and the embarrassing experience of going to lunch with your attending and a few co-residents when you take off your white coat and your little pill box falls out, dumping its propranolol contents all over the cafeteria floor for patients and colleagues to see.  Good thing that didn’t happen to me:)  Thankfully, the stakes are not as high as they were my intern year, when I was in the trenches caring for people on their death beds, where any slip in the wrong direction after 30hrs of sleeplessness could have been a medical error with huge repercussions.  That was an unsustainable amount of stress for me and a burden I’m thankful is no longer mine.  In derm, 98% of the time my decisions as a physician are not life or death.  Put in more optimistic terms, while they cause significant distress and greatly impact quality of life, skin diseases rarely cause people to die (with some exceptions of course).  In pessimistic terms, I’m more likely to cause my patients’ demise than the disease itself, by using potentially harmful meds that attempt to improve quality of life.

On a lighter note, being a derm resident comes with some fun perks…one of which is cosmetics workshop.  Yes, I have fairly strong feelings about what the focus of cosmetic “medicine” has done to the public, as well as what cosmetic dermatology has done to the public’s image of my specialty.  And yes, I swore I’d never partake in Botox.  BUT, I did.  I did it for the sake of my fellow residents’ education of course:).   No, but seriously, it is the reality that this stuff is actually on my boards so I have to be proficient enough to pass, and I also acknowledge that sometimes “selling out to the man” (who pays well) can subsidize other things that I want to do in my future career (ie: work free STD clinics, volunteer my time at the VA and indigent clinics, etc). 

I digress…anyway, over the weekend we injected each other’s faces, and the faces of willing friends and family members, with Botox and filler.  I have to admit, we had fun.  My program held a round of derm interviews 2 days later; we must’ve looked like the island of misfit derm residents because our Botox was “in transition.”  I think half my face was paralyzed and I had a huge bruise on the other half.  Aside from looking like a battered wife for a few days because of injection site bruising, I think it went well.  I did learn, however, why I have such deep rhytides (wrinkles) in the first place…my dermatochalasis is so bad I have to contract my frontalis muscle just to elevate my eyes enough to have decent vision!  So with those muscles paralyzed, I now need blepharoplasty!  Of course, if my eyelids aren’t saggy anymore, my boobs will surely look out of place!  LOL!  And so it begins…(joking)

Before / After (I wish the picture quality were better – I took the afters just now at home in my kitchen with crappy lighting):