Stay Put

My whole life is ambivalence these days.

I have a wonderful woman that I love, who won't quit smoking. I have a brand new Used Car that I love, but it's a Honda Accord, the most generic-sounding vehicle every invented. And now I have a new job lined up for July in an Emergency Room in New York City, but it's on the edge of an outer borough, neither a Trauma Center nor Residency-affiliated.

I'm not particularly peeved about it, but I suppose that's what "ambivalence" means. I'm in a holding pattern for the rest of the year. I took a job by default, a good-paying community job with a swell cast of characters and a couple really good friends on staff, the end result of an ill-defined job search whose parameters were less "A position in Academic Emergency Medicine where my strong interpersonal skills and aggressive knowledge acquisition can be well-utilized" and more "Anyone hire me please." I think I will fit in fine to start my life after residency, but whenever I get to the end of something and start looking back I always look at my skinny little CV/resume/Med School application and wonder, should I have been spending more time plumping that baby up, and less time searching the internet for reviews of cell phones?

I spent my residency not particularly distinguishing myself, much like I spent Med School and Undergrad in all honesty. I have no thirst for research (and I can never think of questions that fit between the bookends of "cannot possible be answered" and "has not already been asked a billion times"), or an overabundance of free time or energy to spend on endeavors like researching and advocating radical changes in health policy. I lack the Medical Heredity that is endowed by institutions like COLUMBIA and CORNELL and their ilk. I don't particularly like spending time with my superiors and prefer to interact only on the basis of performance reviews, which inevitably become a vague rendition of "Good job, buddy!" because of this manufactured distance.

And in the end, I took a good, well-paying job that is at least nominally academic with a staff of people that I very much like working with. So you have to ask yourself, what is the point of all this self-flagellation over unmet expectations? Well, at least no one ever says, "You lack an understanding of your faults."At this point they are very well understood and in fact enumerated in multiple small corners of the internet, if only we all knew where to look.

I still have a few CV's out there plummeting to the depths of the flooded inboxes of Department Chairs on Holiday. I have fantasies where I get several calls in a day offering me moving bonuses and future chairmanships to move to the Hill Country and work in an established Large Urban Trauma Center and then I buy a ranch and some horses and stare up at the uncluttered sky while the music of the moment overwhelms me. But ultimately that is a lonely dream, because there is no one else in it. And anyway I think that if I left too soon, the God who called me here would keep sending great big fish to swallow me up, and drag me back to the shores of Nineveh. Or, at the very least, maybe a few minnows to nibble my toes out of their complacency.

An Impressive Trick

What if I could draw the bridges of New York from memory? Like, I had this one trick where I could memorize that one thing perfectly, and the skills to exhibit it all the time. I bet it wouldn't make much of a difference in the long run. Still, it would be nice to know that your memory was perfect about that one objective thing. It's almost like knowing how to solve the Rubik's cube.

You'd always have that one immoveable unmeasurable thing. No one could take it from you, except if they caused your head trauma, or exposed you to a lot of mercury, or just stood by and let you get dementia eventually.

Still, it would be nice to know an impressive trick like that. Even if only for a little while.

Varieties of Religious Experience

I like to insult New York a lot because it's very different from where I grew up, and because it had so much to live up to in terms of my expectations. So for the past 3 years, I've spent all my time comparing the place to Texas, from whence I came, and noting all the ways in which the City falls short. This is in direct opposition to the quotation I love from Jim Elliot, "Wherever you are, be all there." I haven't invested myself in New York, and consequently a lot of the things that come from truly investing in a place haven't materialized for me. I lack close friends (at least outside the medical community), a stable church home, and because of these things I haven't engaged in the types of activities or discussions that grow from the fruit of contemplation and, in the end, provide a genuine livelihood. To put it another way, I talk about nothing but medicine, or if I step outside of medicine I talk about nothing but pop culture. VANITY! ALL IS VANITY!

So that's the setting for the beginning of 2012, wherein I endeavored to increase the varieties of my experience in New York, to really invest heavily in the lives of others and in the arts, and attempt to expose myself to a variety of experiences which would inspire a revelation of the numinous, that quality of awe/fear/romanticism that accompanies the metaphorical encapsulation of the Supernatural for those of us living in the Natural world. To put it another way, I was trying to open myself up to the experience of God in a place where I'd been feeling my soul going numb.

This experiment has been successful in a variety of ways, but was ultimately hindered by a few things. First of all, mind-altering substances don't seem to be a substitute for exposure to the Numinous in any lasting way. Mostly what I mean by this is alcohol. So since alcohol for me ends up being somewhat of a crutch in the gateway to "feeling my feelings", I was almost required to give that up to approach a healthy and more lasting vision of my future in relation to God. The second thing was a bit harder to give up.

The second thing was my expressed desire to return to Texas at the end of my residency. As time has gone on in New York, I've been feeling the tugging of conviction on my heart about why I was called to New York in the first place. When I came here, I really did feel like it was a calling, and perhaps I've been unfaithful in that. Looking back on it, I wasn't particularly pulling a Jonah and running away, but I was maybe running farther afield of where I should be. And all that running was done with a back-turned eye, making sure to keep Texas in the rear-view mirror as a place to which I would eventually return and start building community. And therein lies my greater conviction. I have failed to build community here, either because I haven't been looking in the right place, or because I didn't prioritize it, or because I didn't have time given the demands of residency. So to sum up, I was feeling deeply convicted about this, in the religious sense, and as I was drawing closer to God and experiencing Him in greater intimacy, I realized that I needed to try and stay here.

When I thought about that decision from outside my own experience, it was something I did not expect to have a great deal of peace about. I've been talking about going back "home" for 3 years now, extolling the virtues of wide-open spaces and gentlemanly behavior, negating all comments about the weather with comparisons to Texas heat, fantasizing about a lake-house in the Hill Country and a daily diet of flour tortillas drenched in queso. However, once the sentence came out of my mouth, I realized that it was the right one, and I felt a great deal of peace about it. I feel trepidation, sure, about the job market, and the spectre of loan repayment, and what the lasting damage might be to my psyche. But those things really seem insignificant when compared to the more permanent joy that you get when you're living right with God. Seriously. I know that sounds ridiculous but it's true.

So while I reserve the right to reverse course and claim that I was just "not hearing God right" later on, for now I'm going to continue to pursue those numinous experiences here in New York, lifting my eyes past the man-made constructions around me to find myself still in the world God created. I'm going to put down roots and open my heart to new people, and subsequently harass them until they're my good deep friends. I'm going to live in community with some God-fearing folk and not isolate myself off in the wilderness of a Midtown Studio. I'm going to close my eyes and listen to music, dance in the minuscule area around me, and watch the sun slink down behind the Hudson, the first stop on its journey across the country.

On Relationship Incompetence

Something I've noticed and that has been commented upon ad nauseum is the main-streaming of Nerd culture. Comic Book movie blockbusters, Apple/computer product fetishism, shoe-gazing singer-songwriter outcast indie music explosion, Zooey Deschanel horn-rimmed eroticism. As a nerdy person it's like becoming the popular person in high school. Which I think any nerd will tell you wasn't so much the goal as it was an idealized juxtaposition to your own life. You didn't want to be the popular person. You just wanted to envy them, and their life. If you became "popular" you wouldn't know what to do with that any better than you did before that transition. Because what it comes down to is how well you handle relationships.

I'm incompetent at them. And I'm going to transition now between talking about general "relationships" and talking about romantic relationships, because I figure the latter is just a micro-analyzed version of the former with greater stakes and even more self-doubt.

So yeah, I'm incompetent. No matter the setup, be it my "First Crush" or my "Perfect Woman" or my "Best Friend", I'm unable to handle these things into the long term. Some of my acquaintances have deemed me a little "Aspergian" which is a label that sometimes seems fitting and other times seems totally crazy. But maybe they're right and there's some mental block in my head that keeps me from understanding or considering the sensitivities or even just the cognition of other people. Take my most recent (failed) relationship. During our final encounter I consistently had trouble explaining what I meant, and how many of the things I've done have been misinterpreted. I just didn't understand how she would react to so many things I did. Nearly all of them turned out to be hurtful. The final sticking point was that she needed me to say (I think), "I won't be mean to you again. I will exhibit patience and try to understand your intentions before I get angry. I will do whatever it takes to make this work." And I couldn't bring myself to say those things, partly because I didn't really grasp that that's what she needed me to say at the time, and partly because I couldn't envision a scenario in which I ever exhibited perfect patience or wasn't mean to her again.

So that's it. That's my autopsy on this most recent disaster. I hope in the future to be able to more fully understand and appreciate those I love. I just don't have the first clue how to go about it other than living through it. So it goes.

Step 3

So I've been on an off-service rotation the past week which consisted of brief stints shadowing dentists. So at the last minute I registered to take Step 3 10 days ago. I took the test today (actually COMLEX level III), and people are right. It's almost entirely pointless to study for that test. There are questions on that test where there is literally no evidence-based answer (ie, what's the best symptomatic treatment for AIDS dementia?). I hope I passed, but I don't know what else I might have done differently, save for more practice questions, of which I only did about 400 (exactly the number on the test). Probably should have done about 1200 like I did for Step 2.

So anyway, I took the test in New Jersey as that was the only testing center around that had any availability. After I finished the test, I walked down to my car and was surprised to find the engine never really caught on. Just kept turning over. And over. And over. In a New Jersey testing center parking lot.

Now my car has been giving me warning signals for a while. CHECK ENGINE SOON. But how soon is "SOON"? And anyway I know what the problem is - my lack of several thousand dollars in my savings account. An amount which would do much to recuperate my car, and maybe even stop it from smelling like gasoline every time I open the sunroof. But anyway, all that is to say that you can know what the problem is, you can be expecting it to rear its head at any time, you can even be mentally prepared for its effects. Up until that time when it finally abandons you when you need it, right after everything was running smoothly. Right after your lunch-break trip to McDonald's for a McFlurry to celebrate. Right after your 8 hour examination on misery and its effects. You can be prepared for the problems, up until the point when they're actually problematic.

Now thank God. Eventually the Creator of Heaven and Earth, the Messiah of the covenant, the Savior of the world heard my prayer and my car started up again and got me back to the Hospital where it resides in semi-permanent retirement (either that or it just happened to catch right at that point, but let's not take anything away from divine intervention if we don't have to). But still, the point was not lost on me.

I know the problem. I even think I know the solution. The question is whether I'm willing to invest the time and money and trouble it takes to fix this heap up. Or if I should just cash in on my soon-to-come job prospects and buy a newer, prettier, more dependable car, like a Kia Soul.

It's a metaphor, you see.

Somebody Goin' To Emergency

I'm reading a book on anger. Actually, 2 books. The first is written by this Buddhist monk and it has a lot of stuff in there about being conscious of every breath and every step and controlling how much anger is embedded in the food you eat (a frustrated chicken that can't move in its cage probably stews its tender breasts in a broth of hate and anger, his thinking goes). Obviously I'm not getting as much out of that.

The other is written by a couple psychologists, Midwesterners, Christians, down-to-earth folk it seems. I'm digging the 2nd one a little more. It's called "Letting Go of Anger" by Ron Potter-Efron and Pat Potter-Efron. I'm not very far into it yet, but there's a group of statements in the Introduction that I was dwelling on today. Specifically the following statements:

1. Anger is an accurate signal of real problems in a person's life.
2. The goal is to solve problems, not just to express anger.
3. Anger is temporary. It can be relinquished once an issue is resolved.

(There's a few more, but lest I plagiarize their entire volume, I'll leave the rest out as they don't really apply. You should really buy the book if you're having anger problems.)

So anyway, I guess that's the problem I'm having. I'm expressing my anger these days just to express some anger, and in some ways to pass shame onto those I love. Or, as the authors state, "You made me feel awful, so I'm gonna hurt you back." Very infantile this brain of mine. But a point remains that in classifying your anger in this way, and in responding to it with the passing of shame from one person to another, you're not responding to the accurate signal of real problems, and you're not using it to solve problems either. You're just passing the anger around the room. This is why New Yorkers are so angry I think. We're all just passing the anger back and forth from one to another.

So I just wanted to share that thought. My anger is a result of real problems, which I've done a pretty bad job working on lately. The problems go unsolved, or in my case get actively worse, while I stew in anger, or pass it around, or make everyone close to me generally feel bad about themselves and their relationship with me. I guess what I'm trying to say is that people are lucky to be friends with me.

Anyway, that's all. I take Step 3 on Monday. I'm just procrastinating really. Also, READING FOR FUN! That's a cool thing to do. Also learning. Also Wild Sweet Orange tazo tea. It's a blast from the past Board-studying days.

Bucket List

I've just recently passed the half-way point of my residency, realizing that I have just about a year and a half left (in all likelihood, although this could change) in the city that never sleeps. I've decided to prepare a bucket list of things to accomplish before I leave the city. Below is it, and in no particular order.

1. See the New York Philharmonic

2. See a concert at Carnegie Hall

3. Go to a game at Citifield

4. Brooklyn brewery "tour"

5. weekend in the Hamptons

6. macy's thanksgiving day parade

7. Bon Iver live (more of a general bucket list item)

8. Knicks game at MSG (not this year ha!)

9. MoMA, AMNH, PS1

10. statue of liberty and ellis island

11. Top O' The Rock

12. Wynton Marsalis

13. steak at peter luger's

14. ice skating in bryant park

15. Christmas Carols in Chelsea

16. NY Marathon (as a volunteer in the medical tent at the end of the race)

17. visit the main public library at Bryant Park

18. movie at bryant park in the summer

19. shakespeare in the park

20. the Book of Mormon

This is meant to be an evolving list, so stay tuned.