we require certain skills

It did not get particularly cool, not in absolute terms. But it's September, and several days had hit the triple digits. And finally, I had a real day off. Oh certainly, I get one day off a week, it's required these days (cue the remarks from various members of the old guard chiming in with 'back in our day, we worked 3 weeks straight without a day off and we weren't allowed to sleep and there weren't any residents to consult' walking-to-school-up-hill-both-ways shenanigans). But this was the first day in a long while that I wasn't distracted wondering about what was going on with my patients, or using that precious day off luxuriating in the opportunity to catch up on laundry and bills.

No, yesterday, there was a slight breeze in the air, and it occurred to me, how fast it's all going by. It's almost the end of September. I still feel like I am at the beginning of my training, but yet some things are becoming intuitive. And I finally had a chance to breathe.

This is not meant to be a woe is me post. I chose this course, and knowing full well what it entailed. And though it's rigorous, I still make time to do what I please. I haven't broken my track record of once-weekly baking excursions (though, unlike in my previous blog-life, I rarely spare a moment to snap pictures of baked goods these days). But yesterday felt like the end of the summer. It wasn't quite the right time to start bringing out the apples and the pumpkins, even though in some parts of the country, it probably feels perfectly appropriate to do just that. I know it's technically more of a spring type of thing, but it felt suddenly like an orange kind of day.

So I bought myself some carrots.

It amazes me how many people love carrot cake. Me, I always had an aversion to it as a child, because I hate raisins baked or cooked into anything. So it was always a profound disappointment to start to bite into a slice of carrot cake and then suddenly be assaulted by soggy raisins. I wasn't too crazy about the overly sweet and thick, coat-your-tongue frosting either. In short, I was not a fan. Maybe there were just no good carrot cakes to be had in EBF.

I'm still a little suspicious of carrot cake, as it mostly to me seems like making a good spice cake. But for some reason, I was in the mood to give it a shot yesterday. There are a few important things I've learned about carrot cake over time. One is that you cannot use coarsely grated carrots. The extra time to shred them super-fine is a bit of a chore these days, but it is worth it. The second thing is that carrot cake is best when slightly spicy and sweet (the latter being an easy task given that carrots have natural sugar in them and then you add some sugar into the batter to push it over the top), but the frosting that accompanies it is best when slightly tangy and just mildly sweetened.

The stakes are a little higher nowadays. I laugh just writing that, because actually, no, they're not. But it reminds me of one of my patients, a 22-year old with sickle cell trait. I was encouraging him to take a walk around the floor today so that he doesn't get too conditioned and so that he doesn't develop clots from lying around all the time. He waved at his hospital gown from top to bottom and said, "I can't walk around like this, I got my image to think about!" It was actually a completely in-character thing for a 22-year old college student to say, but for some reason the nurses and I were in hysterics about it for the rest of the morning. It just struck us as humorous, to worry about your rep when you're in the hospital.

So no, the stakes aren't really higher; that's just as silly as what my patient said this morning. But there are certain things I make now because I know they're reliable. I save the experimental stuff for these true days off, because I know I'll have time to make some boring, standard cookies if the experiment ends in fiasco.

It's funny. When I bake, I miss some people, I really do. I'll bake something and think oh, he would have liked that or she used to ask me to bake this for her or it's too bad he's not around to taste this, it's his favorite flavor. But the lovely thing about baking, and maybe about life in general, is that new people show up. They don't fill the void, they don't replace anyone. They are just new, and somehow, room gets made for them. Just new people, who ask if I knew that carrot cake was their favorite kind of cake. And all I need do is shrug, push a cupcake towards them, and make a mental note to bake them some more at a later date.

p.s. in case it isn't obvious, it is about time for me to give up my ancient relic of a digital camera and upgrade. If anyone has a suggestion for a reasonably priced one, suggestions are welcome.

don't wish it away, don't look at it like it's forever

I have no pictures to share for this post. Right before I started internship, I realized that my digital camera was purchased in 2001. I'll pause for a moment and let the few folks reading recover from hysterics.

There. Anyway, I'm horrible at the taking of photographs as it is, and even worse at remembering to take a photograph when it might come in handy. I guess, in the current age, that makes me something of a weirdo. Well, that among other things. And it is interesting, because every once in a while, I start to wonder if some of the strange absurdities of my life really happened since I didn't document it onto Facebook or commit it to film or photograph.

Luckily, I always have the words. If I didn't write the words, then it must not have been very important is my thinking.

So let me write these words. Two sentences, stated. And then maybe I'll ramble some more.

1) I made cinnamon cupcakes and frosted them with chocolate ganache and they were met with enthusiasm.

2) Internship is, indeed, a rollercoaster ride.

About the first point, there is little to say except I wish I had taken a picture of the little things. Even though the macaron class I took was probably way beyond my expertise and even though I'll likely never successfully recreate the macarons the way I was taught during that lesson, I did learn from that class to get over my illogical fear of pastry bags. Yes, I've now become quite comfortable with piping frosting. I don't think I'll ever be an expert decorator or anything, but it's nice to be able to at least frost a cupcake with a little swirl, that was described by one of the more humorous residents as "professional-like."

About the second point, there is much more to write, but nothing which would be in any way novel or interesting. I suspect every intern feels like this during the beginning of their year. Every time you think you have figured a few things out and you may actually be getting the hang of things, something happens that makes you feel incompetent and makes the learning curve seem hopeless. It's quite the contrast to 4th year of medical school, during which the powers that be act like you are a genius if you can manage to speak without drooling out of the side of your mouth. Now, there's always this feeling of "why don't you know this?" pervading every piece of feedback I've gotten daily.

And every day, I have to stop and realize that this is a universal feeling, and I don't know why everyone acts surprised every year that the interns are clueless. No one has really been prepared for the job, no matter how hard you work during medical school. And even if, by some miracle, you learned how to do your job properly at some point, too bad, because you get whisked off to another rotation before you've had a chance to really get your bearings.

Every day, I have to stop and remind myself of my goals. I have to remind myself that I'm not striving to be a meticulous note-taker, or to be so efficient that I can round on eight patients in 30 minutes in the morning. Yes, these are necessary evils which one must somewhat master during internship, but it's not where my focus is, nor where it will remain, in the long-term.

Then I have to also remind myself that I'm only 4 weeks into working inpatient medicine, which means, I am still in the preemie/newborn phase of internship. There's still a long ways to go, and I, as well as it, will get better. My real goal is to learn how to care for patients properly, and to do that while still maintaining a personality and an ability to interact with people as if they were human beings and not medical record numbers. I just have to keep reminding myself of that.