Vocation story

I have recently finished writing my vocation story! I was hard and easy at the same time. I felt like I should get it "right," and somehow have the perfect version...but that just resulted in me never typing anything. Finally, one day I just sat down and told it. Deo gratias.

Ultrasounds before Abortions

Have you ever been so angry you couldn't speak? I have been meaning to write about a talk I attended, given by Dr. Rebecca Kukla on ultrasound viewing before abortion. Dr. Kukla argued that ultrasound screening has become a ritual in our society to establish parenthood and add (prematurely and irrationally) a new member to the family. Performing an ultrasound and explaining the findings to a woman desiring to end her pregnancy would thus cause unnecessary and severe psychological trauma. She also argued that this imposed moral harm on physicians as it required them to violate their fundamental duties to patients.

I have been meaning to write this post since January. I have kept the folded-up flier from the talk in my desk since then. There it sat, outlasting the semester, my STEP studying, and my move to a different city. Usually, when I keep a piece of paper as a reminder to complete a task (e.g. a blog post, or mailing something, or running an errand), the having of the paper bothers me just enough to make me want to complete the task. But this time, I preferred to keep the paper rather than write the post. I just couldn't do it.

Every time I sat down to do it I would formulate the ghost of an argument, take out the paper, unfold it, look at it, and recall the tone and content of the argument. The first few wisps of a post that I had would evaporate as I would become angry. Not desiring to be angry, I would just put the paper and the idea away.

Today I realized the pattern. And now the flier is in the trash, but I have a decision to make (I am literally making this decision as I type). I can either write the rebuttal now, or I can just forget about it.

I am still too angry for a level-headed, reasoned argument, so if you read this, Dr. Kukla, please excuse me as still young and full of idealism. I will strive to be professional, though.

Before most minor surgical procedures that require general anesthesia (e.g. cholecystectomy or gall bladder removal), an ultrasound or other imaging is done. Vaginal ultrasound is quite common in gynecology. It also doesn't stand out as uniquely invasive. (Ultrasound for cholecystectomy gets to the bile duct via the mouth, and I'm sure you can imagine how they stage colon cancer). Abortions actually become more like the minor surgical procedures they're touted to be when an ultrasound is performed. I would hope they're done anyway.

Adequate bedside manner during any exam or procedure in which a person is awake but unable to interpret the findings includes explaining the findings. "Mrs. Anderson, your lungs sound normal." "Ms. Patel, the skin biopsy is almost over and your back looks good." "Mr. Deere, this darkish color on the ultrasound means you have a lot of fat in your liver." Let's encourage abortionists to have good beside manner by requiring them to describe the findings. I would hope most of them do anyway.

Dr. Kukla's concludes that ultrasounds like this impinge on the physician's duty to do no harm, but she happily supports the procedure that follows, which will leave 14% of the women who undergo it with full PTSD (slide 42). (For reference, 15.2% of Vietnam vets have full PTSD.) Abortion increases the risk of suicide to 650% (slide 74), substance abuse (61 and following), and depression (9 and following)  is considered desirable, so desirable that even medically legitimate restrictions are deemed morally intolerable.

I think that's all I have to say. Dr. Kukla and I agree that vaginal ultrasound cannot be considered a kind of "rape," and we also agree that it's not ideal that these regulations come through a governing body (we'd both prefer they come through professional organizations). But I find her basic attitude (defending abortion while objecting to an ultrasound) to be inconsistent.

Oh dear. Family Medicine.

So, on the first day of the family medicine rotation, the clerkship director gave a presentation about family medicine--what it is, why one would go into it, etc. And something seriously bizarre happened.

I have wanted to become an OB/GYN for something like eight years. Family med has always been the second choice, but it was always dismissed because of things like a preponderance of metabolic syndrome (ugh), no surgical components (double ugh) and excessive government oversight (triple ugh).

But as that clerkship director was talking, I began to seriously think family med deserved a more than serious look. I began to really want to be a family doctor. I began to think so seriously that I started making a list of pro's and con's on my orientation packet. And I didn't even call the con's "con's," I just wrote them under a list I labeled "Hm."

Hm

1. I would miss the OR and surgery. I really like anything that requires manual dexterity.
2. Every time someone suggests FM as a way to go, they mention rural care and mentally I go "ACK! NO!!" I don't want to do rural care. Sorry, but I want to stay in my city! I'm happy to serve the urban poor, and that's what I want to do, but no rural care until my parents are deceased. That's the law (right now).
3. The government looooooooves primary care. FM is the answer to ALL Obama's problems. Hence, I don't want to go into a field where I become Big Brother's employee or marionette.
4. SYNDROME X. Nuff said?

Pro

1. I love to educate, and that is what a lot of FM is. I love to bring people up to speed by going to meet them where they are and encouraging them. That was in my personal statement.
2. Better hours than OB/GYN!
3. FM is actually the answer to MANY of the nation's healthcare spending problems. I don't want to be a governmental employee, but it would be good to actually help with a big problem.
4. I used to want to be a family doctor but somewhere along the line I learned that the golden age was over and family docs were referral machines (it was a job for the dumbest med students). But I don't think that's true anymore, not after meeting some of the faculty here and elsewhere.
5. I was complaining after psychiatry that I wish I'd become a therapist instead of an MD, since they seemed to do more for people. FM would be more like the therapist and less like the drug pusher.
6. It's natural. It's basic. I like that.
7. It's the most helpful, in terms of morbidity and mortality.
8. I LOVE the idea that one person has one doctor, or at least one main doctor managing the team. The patient centered medical home model really appeals to me, as does the ACO, multispecialty practice, and group visit.
9. I like the idea of managing complexity. Although I don't want to manage everyone's unmanageable syndrome X, I do like to use my brain. (IMED, is that you calling?)
10. I like the idea of being able to everything (ish) for the poor.
11. It has a lower income.
12. It's almost all outpatient. One thing I didn't like about psych and a few of the docs I've shadowed is that they have inpatient and outpatient, and spend a lot of time driving.
13. It has a shorter residency AND (get this) you can do a year-long fellowship in OB and then *poof* I would have spent the same amount of time (four years) getting ready for prenatal care as I would in an OB/GYN residency. I'd miss the surgery (except C-sections) but I would be out from under the thumb of ACOG and not responsible for IUDs, sterilizations, and IVF while still managing what matters most to me anyway (prenatal care, birth, miscarriage, prenatal hospice, NFP, STDs, sex and abstinence ed, and postabortion recovery).
14. I might be able to do residency more easily in my home city. And that means, I might be rotating where I will eventually be a resident. (Better shape up!)

I still have a lot of questions, but that is a long list (and it surprised me how quickly I was able to write it out, as though I'd been thinking about this for a while). I'm still in the first week of the rotation, which has all been lectures, so I haven't seen a single real patient. Time will tell. Please say a short prayer so that I can see what God wants me to do.

A patient teaches me how to trust Jesus

I just finished a week working on the trauma floor of the psychiatric hospital. On this floor, patients who have been abused or undergone some other traumatic experience undergo intensive therapy so that they can return to normal functioning. The hospital I am working at is one of the top in the nation for this, so patients come in from out of state to live on this floor and work through their pasts. If ever I went into psychiatry, it would be for this. It has been the most fascinating, intense, and beautiful week of the rotation so far.

There are several patients on this floor with dissociative identity disorder (DID, which used to be called "multiple personality disorder") because of their trauma. I am following three of them. One of them, an older woman named "Bernice," is unforgettable. She underwent a very difficult childhood and has several "alters," all of whom are children.

Bernice is a petite, white-haired woman who uses a walker for stability. I rounded on her the first two days of my week in trauma and learned about her past, her course of treatment, her marriage, her neighbors, her houseplants, and her alters. She was in the hospital now because she was beginning to dissociate again after being integrated for over ten years. She was not co-conscious with two of the alters who had recently appeared, and they had made frank or angry comments Bernice would never have made to others.

"Bernice, how many alters do you have?"

"I don't know," she said. "Before I came in, my therapist was trying to help me meet them. She suggested that, every night before I go to sleep, I ask them to come around a table, and we'd talk about how the next day would work."

My work with other DID patients reveals they often have an inner landscape, so that they can exile alters to islands, meet with alters, put child alters in safe places, and be co-conscious and supervise alters who come out. They describe their alters as "fronting" when they take executive control of the body; they can be "co-conscious" if one is in control and another is standing just behind or listening and thinking about the goings-on of the alter current in front.

"But," Bernice said, reflecting on the meeting strategy, "I would come to the table, but the children would never come." I found it striking that the personalities are different enough to seem to have their own wills. "So," Bernice went on, "my therapist suggested that I find a safe place for them, so that they wouldn't be afraid to meet with me. She had me read the Narnia books. So now we go to Narnia. Have you read the Narnia books?"

I told her I had. Bernice nodded and went on, "so now I go to Narnia, and I start at the lamppost. And Jesus follows me. He's always behind me. Even when I first started therapy, the very first time someone hypnotized me, Jesus was the first thing I saw. My doctor asked me, 'What do you see?' And I said, 'Jesus!' And when the session was over I saw he [the doctor] had tears in his eyes, and I asked him what was wrong and he said, 'Nothing, I just never heard anything so beautiful.'"

Parenthetically, I don't think Jesus is one of Bernice's alters, nor is she hallucinating. He is just such a strong part of her waking life that when she descends into her soul, she finds Him, real and vibrant, waiting to help her. She described her most recent meeting with her alters.

Src

"So Jesus follows me, and we go to look for Aslan. I think we have to find a different place, though, because Aslan represents Jesus and if I have Jesus...well, you see the point. Anyway, this time we went into Aslan's mane and there was a rocking chair and a baby. I sat in the rocking chair and rocked and nursed the baby, and then the children [her alters] began coming out of the shadows. I saw little Bernice [the first alter who ever appeared] and Lucy [an alter she had named after one of Lewis' characters], and about five or six others far off, beyond where I could see their faces. They looked like a paper doll chain, all holding hands. I didn't see Mattie, the one who was so angry. But Lucy I saw clearly for the first time. She had straight brown hair a little past her shoulders."

"And I think," Bernice mused, "Jesus gave me a gift, with the rocking chair and being able to nurse the baby. Because those children have never had a mother, that's the problem. And so when they saw a mother in me, they weren't afraid to come meet me."

I was struck completely speechless. She said more about Jesus: "He's so gentle," she said. "I'm never afraid. Sometimes he disciplines, but He's never unkind."

Another day I went to see her, I found her just as she was leaving group therapy early (which you're not supposed to do; the trauma program is very disciplined, and she apparently had poor group attendance). I softly called out her name.

"Bernice!"

"I hafta go take a nap--" she began, and then she saw me and her face lit up. "Oh, it's you!" she said girlishly. "Okay, I'll come. I thought you were going to be angry that I was leaving."

"No," I said. "Can I talk to you?"

"Sure," she said brightly. "But I have to get a ser'quel first." Seroquel is a drug that the patients are allowed to take as needed for sleep. She said "seroquel" in such a strange way, though. Bernice was an articulate woman and the way she skipped the second syllable was a little too...childlike.

When Bernice and I went into the little office and I closed the door, I asked, "so, who do I get to talk to today?"

And to my amazement, the person in front of me replied, in a pleased but bashful tone, "My name's Mariana."

Emily McGee

And for the next half hour, I talked with Mariana, a seven-year-old girl. Mariana's voice was a higher pitch, her sentence structure was simpler, and she sat like a little girl in the chair, legs drawn up like a little ballerina (whereas Bernice sat like any other older woman with osteoporosis). And Mariana used "we" instead of "I."

"We were thinking about you last night," she said, for instance. "We were thinking about how you have such pretty skin and thought you'd look good in pink, and now you're wearing pink!" And she beamed. She also related to me how pretty her therapist was and what beautiful skin she had.

"Mariana, is this the first time you've come out?"

"Yes," she replied. "It gets so noisy in that group and big Bernice goes away, so I came out. We don't like that group. We hafta talk about our bodies and," she said, looking down at the body of an older woman, "big Bernice used to be really pretty but thirty years of psych meds....so I don't like that group."

"How many girls are there?" I asked.

"There's seven of us," Mariana answered matter-of-factly. "Lucy and little Bernice and--oh! And the one that gets us into trouble when she comes out OOoh!" Mariana made a very exaggerated face of displeasure.

"Mattie?" I asked.

"Yes!" exclaimed Mariana with some surprise. "Did big Bernice tell you?"

"Yes," I said. I wanted to ask more about Mattie, but we ended up talking about the meeting in Narnia, and I got the story from another perspective. "Big Bernice was telling me she rocked the baby, and then she saw little Bernice and Lucy," I said. "And she saw some children holding hands like paper dolls. Were you one of those?"

Mariana was puzzled. I shouldn't have been surprised--after all, it was Bernice who saw the children in the shadows and was reminded of paper dolls. If Mariana was one of those, she wouldn't have that mental image. "I guess so," Mariana said eventually. "But we came because big Bernice looked so motherly. How were we supposed to come to a table if we didn't even know her?"

I learned a lot about Mariana. She told me a little about everyone's history, and how Bernice had to deal with her alters when they first started coming out. Mariana giggled as she recounted some of the troubles that little Bernice caused when she first came out.

"And she was only two! So of course, she di'n't know how to drive. So when big Bernice went somewhere and then we switched, little Bernice didn't want to drive and so we was stuck. And then once little Bernice finally had to drive once, so she got behind the wheel and drove probably twelve miles and hour all the way home. We were so scared! But then she grew up to five, and now we're all seven."

One of the most interesting comments she made was about the group dynamic. Early in the conversation, she saw the blank Progress Note form by my elbow and asked, "Are you going to ask me questions?"

"No," I said, pushing the form away. "I just want to find out more about you. Mostly I just write how people are doing and if they're having a big problem."

Mariana looked worried. "Do you call switching a big problem?"

I shrugged. "No."

She looked visibly relieved. "Some people do," she said secretively. "But it's not fair for only one to be out all the time. We should all get our chance."

Soon, Mariana began to look tired. "We want to go sleep," she said. "And when we wake up, big Bernice will come back."

"Okay, go get some sleep," I said, and sent her on her way. That was yesterday. Today I went to talk with her again (even though I wasn't supposed to round on her) and expected to see Bernice, herself, again.

But Mariana was still out. She looked very tired, even though it was just after breakfast. "I like your chair," she mused sweetly. "It's got a high back, like a queen's chair."

"A queen of Narnia," I said smilingly.

Her face lit up. "You read those books?" she exclaimed. I nodded, and she almost clapped her hands with glee. Just a few days ago, I had told Bernice (big Bernice) the same thing and got a very different reaction.

We talked briefly. "It's hard to look at all those people out there," she said, speaking of the other patients on the trauma unit. "We look at them and see that three-fourths of them will never be well. They will get better, but then they will go back to the hospital. Just like us: we thought we were well, but we weren't. Now we're back in the hospital. We will never be well. We won't."

I gazed at the person speaking to me who had the body of an old woman, the mind of a little girl, and a disease so terrible it ripped her identity into pieces. What an incapacitating condition! (She has trouble with adult friendships and jobs because children come out! Once so functional, she's now in a mental hospital, stuck with problems most people never imagine because they're one whole personality.) I wondered whether I should comfort or reassure her. I didn't, and I am so glad I held my tongue, because she said something I will never forget.

Src

"But you know Jesus? He only gives you what's good. One of the letters that Paul wrote, I can't remember what he says but he asked Jesus to take away something, I don't know what, he asked him three times but Jesus didn't take it away. And that's how it is with us. We think we're at our very worst but we're not. That's when we're giving him the greatest glory. We don't think we can do anything but we can and we do."

I was struck speechless again, this time completely overawed.

What trust! I decided that I have no idea what trust in Jesus really is. I recently read Consoling the Heart of Jesus and thought, "aha, now I know how to trust Jesus!" Formation has been focusing heavily on one simple concept: "God loves me immensely." And so I thought, "aha, I live like a beloved daughter of God so vividly now!"

Nope. I have no idea what trust is. I have no idea what living on divine love is.

Bernice and Mariana do. They walk with Jesus in total simplicity, attached to nothing in this world, not even the hope of being integrated or having a life back. With no vengeance, anger, entitlement, or greed, they walk like children, relying on Him for everything and thanking Him even if nothing seems to come.

At that moment, my attending poked his head in the room. "I'm in here talking with Mariana," I explained, so that he wouldn't address her by the wrong name.

(This is old hat to him; he's been in psychiatry so long that he still has a copy of the DSM-II (we're now in the DSM-5) and he's worked psychoanalysis and trauma for so long that he's apparently legendary. "People come from all over the country to be here," he said shuffingly to me one day, "and part of it's to see me.")

So my attending looked at Mariana and said nonchalantly, "so how long are you all planning to stick around?" He was asking about when she wanted to be discharged. I don't remember what Mariana answered; I was still struck dumb by what she had just said. My attending charted "young alter Mariana out" and we left, but I will never forget that conversation.

Therefore, that I might not become too elated, a thorn in the flesh was given to me, an angel of Satan, to beat me, to keep me from being too elated. Three times I begged the Lord about this, that it might leave me, but he said to me, “My grace is sufficient for you, for power is made perfect in weakness.” I will rather boast most gladly of my weaknesses, in order that the power of Christ may dwell with me. Therefore, I am content with weaknesses, insults, hardships, persecutions, and constraints, for the sake of Christ; for when I am weak, then I am strong.

Discerning Psychiatry

I just finished by NBME (National Board of Medical Examiners' "shelf exam," the final exam we take after each rotation) for Psychiatry. Earlier this week, I had my OSCE (Observed Standardized Clinical Encounter), which consisted of two thirty-minute SP encounters. Psych is over!

In the past six weeks, I have seen 97 different people in a total of 132 visits, 24 of which were "full involvement," including history, physical, differential diagnosis, and treatment. Of note, 40 of my encounters were with males and 92 were with females. This is probably because 1) More women have psych issues and 2) I selectively picked up women's charts when I could. Also of note, there was only a single Asian patient; all the rest were black (30) or white (93). The largest age group represented were the 45-to-60-year-olds, but that's also slightly off probably because I had to guess on some people.

So, what to think of psych? I'm not sure, to be honest. The hours were decent and I enjoyed talking with patients and being part of their care. It was hard to see so much suffering, but that wasn't demoralizing until I got really tired toward the end. I actually felt a little energized by the opportunity to console people in such dark places. (It was unsatisfying not to have continuity of care with those people!)

Toward the end of the rotation, I had a pretty bad week because I got really fed up with the way mental healthcare works, at least in my county. Managed care and third-party payors seem to have really goofed up care. In my grandparents' generation, people were hospitalized for a year, on average. In the hospital I just finished working at, the average stay is 7-10 days; four weeks for people with really good insurance and the older patients on the geriatric unit, who have no other place to go. It's the worst for the poor and the elderly, who should have special privilege.

I was really upset by the amount of control the insurance companies had over the patients' stays. One patient I saw needed to stay but couldn't, and we pretty much had to turn her out, tearful and still needing help. Another patient I saw couldn't get an outside placement at a nursing home unless the doctors made it look like they'd done something to change his status, so his medications were changed (increased) without need.

To be fair to psych, I was cutting back on my eight-hours of sleep, which I've had since before college. And also to be fair to psych, I wasn't getting a lot of exercise. So, the daily schedule during Psych:
5:30am: wake up, eat breakfast so that we keep the fast!
6:10am: leave for Mass
6:30am: Mass, Morning Prayer, and meditation
8:00am to 12:00pm: work at inpatient psychiatric hospital. Midday Prayer if possible! Commute to...
1:00pm-5:00pm: observe at outpatient psychiatry practice, or sometimes lectures, or (four times) a shift in the admitting department until 11:00pm
6:30pm: home, dinner, Evening Prayer. I'd study sometimes in the evenings, or hang out with my family. Formation once a week!
10:00pm: Night prayer and bed.


So, things I liked about psych:

1. talking with people about serious stuff
2. some of the faculty
3. being independent: writing notes, writing prescriptions (even though my signature still doesn't count)

Things I didn't like about psych:

1. talking with people about serious stuff ALL THE TIME.
2. the rest of the faculty (was it just my hyperawareness of abnormal psychology or did some of them have mental illnesses?)
3. the insurance companies' control
4. the feeling that none of the problems were actually fixed by the doctor: the therapist did most of the real work and the helpful work (chemicals are great but not as good as therapy, it seems), and the past problems were past and it was too late to prevent them.
5. not being able to answer people's questions about their conditions and medications.
6. the slightly demeaning way in which all the doctors talked about the patients

So, some of those (e.g. #2 on the pro's and #4 on con's) are just effects of being a medical student on her first rotation. And some of them are purely situational (the faculty ones). And although I enjoyed talking with people, I got a little fatigued by the end of the six weeks because of the nature of the pathology, the payment system, and the mounting feeling like psychiatry isn't the kind of work I want to do. The attitude it engenders towards patients (#6) and the unhelpfulness (#4) is diametrically opposite to my hopes for myself.

We'll see what family medicine has to offer. Here we go!

There is so much unfinished philosophy of the mind.

I wish the Catholic Church was still shaping the world! The Middle Ages were so awesome. If the Catholic Church still informed the world, we would inquire about the ethics of a thing or theory before or very shortly after it was discovered/described/invented. And true philosophy would follow the natural arts and sciences, with theology (well served) flowering afterwards.

In my imaginary Catholic world, a physician treating mentally ill patients could have a pocket copy of the compendium of teachings describing how God works in, through, and for the mentally ill and disabled.

Sadly, this is not the case. Instead, I wander the halls of the psych hospital with question marks buzzing in my brain, wondering whether my patients can cooperate with grace or can receive sacraments. I will now have fun flouncing around in the fields of philosophy. Sorry to anyone who actually likes to proceed in an orderly fashion.

Psychosis and Choosing the Good
By nature, a human being has a body with many organs, and a soul with several faculties by nature. According to Aristotle (complemented by modern medicine) the faculties of the soul

1. special senses (e.g. taste, touch, proprioception),
2. the common sense (no, not "common sense," but the common sense, which compiles sensory information into a whole),
3. the imagination,
4. the passive and active intellect, and
5. the will.

None of these are synonymous with the person. In fact, the error that a person is synonymous with their faculties is rampant right now: we see it borne out in abortion, contraception, and euthanasia. If it can't ______ (see, hear, feel, think, be aware, etc), it's not a human person or, at least, it's not worth defending in the same way that a human who can ______.

Like the unborn and the elderly, the mentally ill have absent or impaired faculties. I suggest the common sense, the imagination, or the intellect is most affected in them. But does this mean they are not persons? No! Does this mean they cannot accept grace? No. (Their wills exist and can act independently of their intellects, perhaps like mine does when I make an act of the will to accept the God is Triune, although my intellect can only shrug and say, "well, St. Thomas said some true stuff about it, but I'm stumped.")

I tend to identify with my intellect. This is not a true or good thing, as seen above. I fall into the same error as our culture does--I need to be more humble, accepting that I am body and soul, matter and spirit. Even so, it is a smaller error to identify with one's intellect than to identify with one's body. The "best" error, the one closest to the truth, would be to identify with one's will. Maybe the attraction to identifying with the intellect (or will) is an old remnant of Eve's mistake, wanting to see herself like God (who is his intellect and will).

Body and Soul: We're Embarassingly One
How bodily we are! Scholastic education is awesome, but it makes me tend to think soul and body are basically separate. That's impossible to think in a psychiatric hospital.

Bodily illnesses have cognitive consequences. Liver failure? The poisons in your blood that your liver can't take care of will make you forgetful and disoriented. Brain injury, even so suble that we can't see it microscopically? Pseudobulbar affect causes people to burst into tears or laughter with the slightest provocation (or none at all). Schizophrenia is associated with decreased cortical mass. More obvious examples are Kluver-Bucy syndrome, Pick's disease, and frontotemporal dementia.

And mental illnesses have material remedies! I saw at least three patients with extreme and overt psychosis become connected with reality in a few days after giving them antipsychotic drugs! Pills can take away delusions and hallucinations. (One woman insisted that I call her First Lady Savior; I just saw her earlier this week and she is completely coherent and herself again. Thanks olanzapine.) The walls between form and matter are becoming preeeeeetty thin here.

Anyway, I just wanted to muse on these things, because I can't really start chatting it up about form and matter with my fellow medical students or attendings. (I never realized how awesome it was at TAC to sit down at a lunch table and talk about first principles.) Maybe this will jog some interesting thoughts in people and we can muse more in the comments?

An Open Letter to Christians

Dearest sibling,

Recently I attended a lecture by a man who claimed to be a deeply religious Christian but lived against some of its tenets. When an audience member asked him about the disparity, he shrugged off the difficulty as ethereal. "Look at Christianity," he said. "People have all kinds of interpretations and translations. Some people include books that others don't." He effectively said, "Christianity isn't one thing, it's a free-for-all, so I make of it what I choose. And that goes for any of my other actions! I do what I choose, and it is good."

Dear Christian, this goes against what we believe. We do not choose what is true and what isn't! We are chosen, we are added to the Lord--conformed to Him, made like Him! It is a beautiful, saving obedience. We know this, and we hope to spread this knowledge to others so that they, too, can be safe in holiness.

I call us to unity. We are giving scandal to the world by being so separated. We are lending credence to faults and sins that pain our Lord! We must stop it, and we must put effort into stopping it!

On my way to work I drive down a block with six churches of various denominations on it. Flanking both sides of the street and one right next to the other, they stand like detached body parts of a man horribly wounded. How can we stand to see our Jesus like this? I call us to knock on our brothers' door: knock on the door of the church nearest you and set up a meeting. Talk about what you have in common. Talk about unity in the next fifty years. Talk about stitching our Lord's wounds closed. And talk about setting an example of love, unity, and radical holiness to our world.

With a fond embrace and with Jesus among us,
Your sister in Christ

My STEP score came back!

I have all these ideas for post and not one of them is going to happen! I wish I could elaborate them all into fully-fledged posts, but I can't because 1) I don't have time, 2) when I do sit down to it, I can't slow down mentally, and 3) I'm thinking in short abbreviations and in the fragments of sentences we use in progress notes, so I can't write well.

We will now publish about six posts which, while half-baked, have GOT to get out of the "pending" box.  Here's number one.

---

I had completely given up on hearing about my STEP score, and was awash with the busy-ness of third year when I got an email from our class president one Tuesday night. It was in the tone of a very intense pep-talk, and I was confused until there were enough sentences like “this is an important score for all of us,” and “it’s a big day tomorrow” so that I figured STEP scores must be coming out tomorrow. Then I promptly forgot this and worked most of the day on Wednesday without being able to check the number.

At 1:00pm, all of my classmates who are on this rotation were together and relatively idle after lunch. Everyone else had checked their scores, so I picked up my phone to check my email and find out mine.

Well, I got as far as checking my email. My phone loaded the (six) new messages and then I had to admit a patient. (That was one of the four Wednesdays we have a shift from 1pm to 11pm in admissions after a morning working at the hospital.) I came back from the admission and stood in the corner by a cubicle with my phone to check the score report.

I jumped through a few hoops (had to find the ID to get myself into the website, guess my password, etc) and then opened the PDF of my score report on my phone. I looked at the number and felt diaphoretic. It was a very, very good score.

Around me, the admissions office buzzed and whirled. I felt sweaty and weak and shocked! God had given me an extraordinary gift. A score like that meant that I will almost certainly get a good residency, and it is even likely that I’d get one of my first choices. Wow! I was shooting for average and scored really well!

I didn’t tell any of my fellow students my score. I hesitated even to post about it here because I know some of my classmates know about this blog. I’m hoping, though, that third year is swallowing everyone’s time and that no one will see this.

I heard my peers talking amongst themselves about their scores. I was amazed that some people who seem to study more than I do got lower scores than I did. I must have just guessed correctly on all the questions I guessed. Then my classmates started talking in hushed tones about people who’d scored ten points below me. Finally, they mentioned that one of the men in our class had scored ridiculously high--they mentioned the number, which was one point below my score. I stayed silent. It would have been completely inappropriate to share my score, and I would have been really uncomfortable if anyone asked. I just stuck to repeating that OB/GYN needs an “average” score, that I was aiming for a 223, and that I was pleased with my score.

DEO GRATIAS!