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past entries

the bumpiest road.

I have never been one to do the easy thing or take short cuts.  I can be fantastically lazy, but it's as if I am drawn to that which will bruise me, the road that will make me fight for each small victory.  Not infrequently, I look at some of my choices and think -- why the hell did I do that?  Not because I am embarrassed by the life I am living -- in fact, much of what I do makes me quite proud -- but because I can't seem to freaking relax.  Ever.  Have an extra hour in the day?  Should probably do a spin class on top of that yoga class.  Getting to the hospital early?  Of course!  But not before I make a healthy breakfast and lunch, do my hair and makeup, and clean my apartment between the hours of 4AM and 5:30AM.  

Swear to God(dess), this is not humble bragging... because I've learned some pretty tough lessons in 2014.  Humbling lessons.  Sadness and loneliness that I sometimes think I'd rather forget.  

You see, this quest for productivity means a few things.  First and foremost, I stay hella busy.  Busy enough that I am not generally alone with my thoughts.  It also means that I look at other people's lives with a weird mix of jealousy and judgement.  I am simultaneously thinking: Stop complaining and get your life together!  AND I really wish I would allow myself some downtime.  

Lately, the balance has been even more tenuous.  A series of pretty bad heartaches befell me this year (although, befell is not the right word, becuase in truth, I am culpable), and it has left me a lot of time to contemplate the meaning of life and other things I can't really figure out.  For instance: myself.  I can't figure myself out.  It's a kind of existential crisis.  Who am I?  What are my goals?  My life seems pretty good--why does it also seem vapid and on the verge of destruction?  

This latest heartache was truly head-spinning and left me with a lot of questions.  Now, initially I was pretty angry.  How dare someone point out my various weaknesses!  Why did I allow my vulnerability to show?!  What am I to do with this ... information?  Then, I realized that these exposures were a gift.  While I initially judged myself harshely for these flaws and weaknesses, I have come to appreciate that the pain of this process meants I was coming in to myself. 

Lately, I have been occasionally mourning my cognitive dissonance.  It was kind of nice to be blissfully unaware of the psychodynamic underpinnings of my social deficits.  I think everyone is aware of their flaws--it's hard not to be, much of the superficial is shoved down our throats on the daily--but aside from hating my body from the age of ten, I actually thought I had my shit together.  Oh how wrong I was. 

A few years I began to notice that I truly worshipped alone time.  I would leave parties or even small gatherings feeling exhausted.  A little reflection made me realize I had always been this way.  I was happy to play by myself as a kid, often spent recess indoors on a computer, and had only ever done solo sports.  This revelation didn't really bother me all that much.  I was actually pretty good at being social.  Despite my propensity to isolate, I do well in a crowd.  It just leaves me feeling exhausted and craving quiet.  

This need for space and time, however, puts pressure on a relationship.  Especially when you are working 80+ hours a week.  Think of your hardest, longest day at work in the past year.  When you came home, were you feeling amorous?  Did you want to chat and relax with your loved one or friends?  Or did you eat a pint of ice cream and cry for a little bit?  Now think of about 14 of those days back to back.  That is residency.  Add that exhaustion and emotional fatigue to the needs of a true introvert and you have a pretty shitty romantic partner.  

The problem is that I allowed that to be the demise of my relationships.  Instead of fighting through it and figuring it out, I allowed myself to lose two women who were amazing humans.  And I got really stuck on that.  Really stuck.  I saw other partnerships weathering residency just fine and wondered, what is my problem?  It wasn't for lack of love--that's for sure.  The depth of my feelings has been borne out in the physical aches I've felt since the end of my last relationship.  

It was in that relationship that I began to realize that I needed to deal with all of this.  With her help (although, I'll admit it felt more like an attack/criticism at the time), I realized that I had been carrying around quite a bit of hurt.  I will spare you the laundry list of interpersonal deficits I created.  Suffice to say, at the end of that relationship, I felt pretty low.  I was pretty sure these qualities I had discovered made me, essentially, unloveable.  

In retrospect, I realize that was not her goal.  She was trying to get to know me.  And she was so freaking good at it, she laid bare my deepest insecurities.  Perhaps for some people this feels cathartic--to love someone so well that you can share all of the ugliness with them--for me, it was laying stones on a road to implosion.  I had spent so little time thinking about these insecurities (save for the body hate--that's always been forefront), that it felt like a smack in the face.  My thought process looked like this:  Oh God.  This incredibly gorgeous, kind woman now knows how terrible I am.  And I do too.  And I've never really thought about it.  Oh God I need to get out now.  I need to figure this shit out.  I need to make myself better.  

So that's what I set out to do.  Flawed thinking, I know.  I ran away from someone who was trying to get to know all of me.  I ran away from someone who made all those Pinterest cliches make sense.  

But I needed to.  I realized that now is the time for me to figure out me.  

So I started doing things that made me feel good.  

I joined a yoga studio and deepened my practice.  I realized that my body is strong and my thoughts are powerful.  I realized that the more I challenge myself in yoga, the more I can connect with stillness.  True stillness.  Not list-making stillness. 

I started spending some nights/half-days on the couch, watching TV that makes me happy.  And allowing myself to not feeling guilty.  And damn--it feels good to curl up under a blanket.  No wonder people have been doing that all these years!  

I let myself go to bed at 8PM.  Or 11PM.  Instead of being constantly mindful of the number of hours of sleep I (think) I need, I just listen to my body.  I am tired?  I should go to bed.  I want to do a few things before sleep?  That's cool too.  

I allowed myself to feel a lot of feelings.  This sometimes means crying alone in my bed.  Mourning over the losses I have experienced this year.  It sometimes means allowing myself to miss people--my mom, my former partners, my friends in Michigan and elsewhere.  It also means permitting myself to revel in deep joy from time to time.  I like to let myself feel my heart explode when I see a therapy dog.  I like to feel that deep chest feeling of pride when I get in to a really tricky asana.  

I made a bigger effort to connect with other women--friends and mentors both new and old.  It's amazing how uplifting female friendship can be.  My heart has felt so warm and I have felt so full and greatful for these experiences.

I have allowed myself to read for pleasure, rather than learning.  And in the process, I have learned a great deal about things that matter.  Things that are bigger that me.  Reading used to be one of my great joys, but from the start of undergrad, I was overwhelmed by the obligation of reading heavy texts that sucked the fun out of the process.  I still have plenty of heavy crap to read, but tonight, I'll be in bed with Amy Poehler.  Love that gal.

I have burned a lot of candles.  Expensive ones.  And they smell great.  Worth every god damned cent.

I have allowed myself to dream a bit.  Where do I want to live?  Who do I want to be with?  I just try not to do it with a timeline in mind.

It's been a rough year.  I have a lot of rebuilding to do.  A lot of reconnecting to do (both with myself and those I've been neglectful of).  That being said, I am feeling like my optimistic self.  I am doing the things I need to do to feel whole.  

Namaste, y'all.


on residency.

I have seen so much sadness in the past six and a half months.  I have done so many 'death exams.'  I've ruined more sets of scrubs with bodily fluids than I know what to do with.  But I love my job.  I've hugged more patients than I expected and spent more nights crying myself to sleep than I did as a teenager.  I've leaned on Jess in ways I never wanted to. 

Internship is a rite of passage for doctors--a notoriously hard year that most attending physicians shudder to think about.  Sure--its hours have grown shorter (now limited to 80 a week!), but it's responsibilities have changed, and the pressure to get everything right only grows.  I didn't realize how care free medical student life is (save for all those exams) until I had my first crop of patients that I was ultimately responsible for.  When I go home at night I am never settled, all I can think about is labs and x-rays and procedures and if my patients will cause trouble for the night float.  Will my 90 year old with atrial fibrillation be able to be rate controlled?  Or will she have a stroke?  Will my patient with the mystery cough and weight loss start to understand the gravity of his situation?  Or will he go out for a few smokes and breathe in the same fumes that likely set him down the road to lung cancer?  Most of the time, between 7PM (when I get home on average) and 9PM (when my lame ass goes to bed), I am a basket case.

Don't get me wrong, there is a lot of joy.  It's no secret around my clinic that I have a favorite patient and that her success (which is actually all hers, and very little mine) keeps me afloat.  The happiness I derive from the lives and stories of my patients makes everything worth it--three times over.  I have also never been more proud to be a physician, I have never felt like I have earned something quite like I earned this.  (Perhaps that's because I have lived a crazy privileged life and it could be argued that I haven't really earned any of my acheivements in their entirety.)  I am proud to stand among other doctors who have gone through the same trials and faced the same challenges.  It's like a big club of tough-as-hell nerds.

I should have been writing though.  I am sure my mental health has suffered for lack of reflection.  Several things have held me back--I am sure you know I will mention time.  Time has held me back.  I just don't have any.  And then the time that I do have is torn between QT with Jess (most of which I spend word-vomiting or crying/laughing about some patient/work story from the day), time at the gym (very proud when I work this in), or time in front of the TV/laptop (which, honestly, feels so good at the end of day).   Pretty much the last thing on my mind is being self-reflective, because I know I'll find a lot of reasons to be sad.  Here is a list of reasons I don't love myself at the moment:

  1. I have a bum left foot going on a month now.  Why haven't I fixed it/gotten it checked out?  Oh I don't know.  All the reasons above, and the fact that maybe if I stare at it enough I'll develop XRay vision and be able to see what's wrong without having to pay the copay for an MRI.   Also, I'm an MD.  Shouldn't I know what to do?
  2. Less frequent trips to the gym... directly related to #1.
  3. My disorganized presentations on days when I feel disorganized.  If I am feeling off on a certain day, it really shows on rounds.  And it's embarrassing.
  4. My proclivity for products with warmth and cheesiness--think pizza and mac and cheese.
  5. The fact that I preach self-love (within reason--I also believe in being the best you can be), but can't practice it.

So, in order to avoid self-hate, I try to keep things as light and fluffy at the end of the day as humanly possible.  This would also explain my distance from all things political this year.  I am pretty sure I'd have a melt down if I fully understood the state of reproductive health in this country, at the moment.  And so, avoid I have.  This feels like an admission of guilt, but I am pretty sure it's a tactic of self-preservation at the moment.

These feelings/struggles also explain my hilarious purchasing habits over the last six months.  There has been an uptick in acquisition of all things comfort: comfy pants, comfy undies, blankets, aforementioned mac and cheese, and anything that brightens my day or makes me happier.  I have also painted my nails more consistently in the past six months than I have done any other thing--maybe including showering.  At least my hands look good.  Don't look at my legs (hairy) or my roots (egregious). 

I think I will get around to recounting patient stories again.  At least, I'd like to.  Being a resident has also made me more acutely aware and paranoid about privacy.  The current plan is to share stories in a vignette fashion--meaning, they won't be about any of my patients in particular, but will touch on things I have seen in a more general way.  I'll probably start with end of life stories, because those have really dominated a lot of my experience thus far.

Oh I missed this.  I do love writing.  Hopefully I'll be back in the saddle soon.  Perhaps tomorrow.  I do have it off, but I also have nails to paint.



I am happy to announce that Jess and I have finally arrived in Pittsburgh!  Our home is absolutely wonderful--great area, lots of space, park for Pita, fab neighbors, etc.  I am super happy to be in my new city and looking forward to it becoming just as great a place to call home as Michigan.  For the past two weeks or so I have taken advantage of exploring the 'burgh and I am finding that it will be a great fit for me.  (And hopefully for Jess!)  One of the coolest things about Pittsburgh is that it's organized by neighborhood.  Yes, it has your standard downtown with big buildings and people rushing around, but it is also home to many little downtowns, streets of shops and restaurants with their own unique feel. There are young neighborhoods, mixed neighborhoods, gay neighborhoods, hipster neighborhoods, fancy neighborhoods, and (of course) just 'hoods.  It wouldn't be a city without some struggle, eh?

In any case, I am glad to be here and look forward to doing a bit of writing before my program starts up.  Hopefully my next post will be about a little incident we had involving Pita.  Actually, it didn't really involve her at all, just her looks and the fact that they are suggestive of her (likely) pit bull heritage.  As a preview I will say Jess and I were sad and mad, but it all worked out.  However, it inspired me to do a little more research about rights and rules regarding breed specific regulations.  So!  More on that later!

I joined a gym yesterday--LA Fitness, formerly Urban Active.  I told myself (and Jess) that I wouldn't be joining a gym til I was sure I had time.  Then I remembered that even if I don't have time, I feel like there is a hole in my heart if I don't belong to a gym.  The start-up fees were hefty: a $140 joining fee and also the first and last month's monthly fee ($40 each).  The gym is a dream though!  It has all the amazing amenities of my previous gym (shout out WCC Health and Fitness Center!) and a lower monthly cost--approximately half to be precise.  So that is fly.  There is a pool, but it is 22 yards and they keep it around 80F.  (Swimmers: word, I know.  I won't be using it for fitness purposes.  Also, how the hell do you keep track of yardage?)  I am also pleased with the selection of machines, number of Spin classes, presence of yoga classes, towel service, and general young feel of the place.  Additionally, they have this place called "Cardio Theater."  I have never seen anything like it.  They play a movie each day in a dark, cool room and there are about 20 cardio machines in there.  Stacked, like in a movie theater.  So you can run and watch a movie. WHAT?!  So cool.

This morning I have my 'fitness assessment,' which I am dreading.  In terms of fitness personas, I have always identified as a former athlete/athlete.  I work out to feel powerful and fierce.  I have never had a perfect bod, so I abandoned that goal long ago.  My body right now, though, is so out of shape that it's pitiful.  I was explaining to the guy doing my 'intake interview' yesterday that I don't feel like I can tell my patients to work out unless I do the same.  Also, I fucking miss having defined muscles.  So: back to the gym I go.  I am a little nervous for this assessment; the guy doing it is a total meathead.  I met him yesterday.  He has NO neck.  And he was eating a tupperware of ground beef.  Yikes.  Hopefully he doesn't break my spirit.  Or maybe he should.  Good thing I got my new Lululemons to make me feel powerful/chic.

Also, a makeup review soon.  I am now a glossybox gal and plan on being diligent about the reviews.  Note: I said PLAN on being diligent.

Come visit!


my biggest secret.

I feel like a local news host, or a tabloid.  "CELEBS BIGGEST SECRETS REVEALED."  Except no one really cares about mine.  Especially because it has nothing to do with sex.  (Sorry!)

This blog, by and large, is about science and medicine and politics--realms in which I am very comfortable.  As I have mentioned before, I write to share, explain, and learn.  This blog has been an absolute godsend over the course of medical school, even if it has been underused at times.  My identity is pretty tied up in the things I am good at, as I suppose is true for most folks.  If someone posed the question "what do you do?", I'd say I take care of patient's physical and mental health.  If you asked me what I am passionate about, I would tell you that politics and social justice occupy the grand majority of my conversations and brain space.  If you asked me what I love to do in my spare time, though, I generally don't have an answer.  This could be related to how little free time I have had in the past 10 years, but I think it's also because I am totally embarrassed by my hobby: making myself look good through hair/makeup/clothing trickery.  I was going to just say: 'making myself look good', then I realized that would include being a gym rat which, sadly, I can't claim to be. 

Yes, it's true.  I am incredibly vain.  That being said, I promise that I keep my vanity to myself.  Though I may be obsessed with tightlining my eyes and straightening my hair and finding high quality denim, I do not expect the same of others.  In fact, I think I am most judgy of my beauty-snob cohort.  Why do they look so good?!  Because, despite the fact that I spend all of my 'play' money on my hobby, I rarely find the time to actually 'look good.'  I love buying high dollar concealers and beautiful tippy high heels, but on my days off you will likely find me in lululemon (also way too expensive!), browsing the aisles of Ulta and Sephora--probably drooling. 

Right now, I am in a weird (wonderful) period between medical school and residency.  In 14 days, I will be Em Ketterer, MD (holyshitholyshitholyshit).  In the mean time, I have excessive free time.  As Jess and I will be moving to Pittsburgh, some of this time is being spent packing, planning, selling and buying.  However, the other 50% of my waking hours is dedicated to... makeup.  And clothes and jewelry and hair.  I have recently discovered the fun of makeup and beauty tutorials on YouTube.  I truly wish I hadn't.  In the past week I have wasted several hours watching really pretty women make their faces look even prettier.  I guess I shouldn't call it wasted time, after all this is my version of scrapbooking/sports/music, people.  I am admitting this to you.  I, Emily Ketterer, am a product snob.  I can ramble off the 5 best-selling MAC eyeshadows, I could tell you what your perfect beauty balm would be, I could teach you how to change the shape of your face with a few powders.  And yet... I walk around without makeup most of the time.

Maybe I should have gone to cosmetology school.  At one point in college, I told my parents that I wanted to go to Douglas J (an Aveda cosmetology school--very chic).  They laughed and told me I could kiss my college funding goodbye.  So I went to medical school (y'all know it wasn't that straightforward, but that's the short version). 

So instead of being embarrassed by my little habit, I have decided to embrace it and use the techniques I know.  I will be the perfectly coiffed resident who is also incredibly sleep deprived.  But my hair and nails and eyes will look impeccable.  Shallow?  Sure.  Happy?  Yeah. 

And now, I will share with you the bounty of my beauty booty!  Here are a list of my favorite things (right now):


1) Makeup Forever HD Foundation: This foundation comes highly recommended from just about anyone who knows and loves makeup.  It covers quite well but doesn't feel excessively heavy.  Depending on how you apply it, it will be sheer or the coverage will be more fully.  (Use a Beauty Blender for sheer coverage and a flat kabuki, Sigma is awesome, for full coverage). 

2) MAC Eyeshadow in Naked Lunch: This is perhaps the prettiest shadow I have ever owned.  It's a beautiful light golden pink that works well as a base for most looks.  It isn't too shiny, but it does have some golden flecks in it.  This is one of MAC's best sellers, and it will certainly always be on rotation for me.  (It's great for pale people!)

3) Dr. Lipp's Nipple Balm: Not just for nipples!  I am a total sucker for weird products, and this one just called my name.  It was in one of those little boxes near the checkout at Sephora and I had to try it.  One of my biggest beauty hangups is my super super dry lips.  They are chapped, cracked and bleeding almost year round.  I have tried pretty much every product you could name, but none seem to work too well.  I love the Nipple Balm not because it has healed my lips completely, but it is wonderful for covering them all night.  I religiously apply a healing balm at night and this is one of the only ones that stays on til the morning.  Progress!

4) Nars Exhibit A Blush: Now, this is NOT an every day blush.  If you follow the link you will see that it is BRIGHT red.  For a blush like this it is absolutely crucial that you have an appropriate brush for application.  I like the Sonia Kushak duo fiber stippling brush because it is not a dense brush and a very light sweep across the pan will give you PLENTY of color.  The reason I like this blush so much is that it is incredibly flattering on pale skin (also on very dark skin).  This is one of the few brushes that looks best when applied to the apples of the cheek.  If I am using Exhibit A, I will do a very light neutral eye and a nude lip.  I like to let the 'just pinched cheek' look be the feature of the look. 

5) Benefit They're Real! Mascara: I am one of those pale people that also has light-colored lashes.  They are there, but if there is no mascara on them, they look... short.  I appreciate a good mascara and have always found that paying the extra for a high-end brand is actually worth it.  This one has really got me hooked, though.  It does it all (lengthens, separates, thickens), and for me, it's good for every day wear.  It might be a bit too dramatic for those who are already well-endowed in the lash department, however.  Tip: when applying mascara, start at the very base of your lash and wiggle the brush side to side until the lashes feel completely surrounded by the brush.  Continue wiggling the brush as you move it up.  The strategy changed my life in college.  Maybe not, but it was pretty exciting.  It helps separate the lashes and get an even coat.

6) Sonia Kushak Eye Definer and Rimmel London Kohl: I know I have mostly only posted high-end stuff (I won't lie, it makes a different 75% of the time).  These two eyeliners, though, are pretty standard for me.  Kohl is the only kind I find that I like because it's soft on my lid.  I find applying eyeliner pretty painful, so it's important to me to find a soft kind that won't pull on my lids as I apply it.  Both of these work great (I like the line of colors Rimmel has), but they can get gloopy by the end of the day.  Just depends on if you're a sweaty beast like me!


1) Pantene Pro-V Overnight Miracle Repair Serum: I LOVE this stuff.  It is not really a serum in terms of texture, more of a gel-creme.  There are a lot of overnight serums that can leave you a little greasy and are designed to be washed out in the morning.  This one doesn't have to be!  Considering I am lazy and hate showering in the morning, it's great for me.  It just makes my hair very soft and I was incredibly surprised to find that when I went to bed with straight hair and this product in it, I woke up with perfectly straight hair.  Normally, my hair in the morning is full of kinks and definitely requires some styling.  Not with this stuff!  Love it.

2) Fekkai Technician Color Care Mask: I discovered this stuff via a sample at Sephora.  What really got me hooked was the smell!  It's like candy or something.  Yummy, but not overpowering.  This is great for anyone that colors their hair (bleach or color, doesn't matter).  I am a big fan of masks and tend to use them once a week or so.  This one has been my favorite for about five years.  Surprising, because I never keep anything that long!

3) Tigi Pro Fat Curl Styling Stick: I actually had no idea how expensive this was until I googled it to find a link for y'all.  Shit!  I got it on super duper clearance ($30?) when BeautyFirst was closing.  I was an early adopter of curling sans clamp.  I watched a tutorial many moons ago and was amazed to see how different the curl looked without using a clamp.  I saw this iron and decided to give it a shot.  Dang!  It's awesome.  I hope it lasts me a long time. 


I think I'll stop there.  That's enough vanity (sharing) for one day.


the ER--part 2.

*Please note, the names and details of patients/staff/friends/family have been changed to ensure anonymity.  I have attempted to stay true to the nature of the stories in as much as their identities can be concealed.

Since the last one was kind of a downer, I am going to relay a (semi) uplifting story next. 

There are a surprising number of people who come in with 'vaginal pain' as their chief complaint.  Aside from being quite vague, it's almost always an indicator that the case will be a doozy.  People don't just come in to the ED with vagina questions--they come in because something went wrong.  Down there--as they say.

I actually like these cases.  I am not a huge fan of doing pelvics (probably because I am also not a big fan of getting pelvics!), but I love women's health and I am always eager to improve my skills.  I want to learn how to make an annual exam as painless as possible--and that requires practice.  Sorry ladies of Southeast MI, I do appreciate you letting us learn how to be doctors.

This particular woman came in with 'eye pain,' though.  When I went to see her, she was sitting perfectly comfortably on a bed, playing with her cell phone.  The nurse had already alerted me that this young lady was also worried about some kind of STI.  I understand--you're embarrassed, but you might as well get it out of the way by being up front in triage.  In any case, I went to see her in an area where we had absolutely no privacy.  I alerted nursing that we would be needing one of the individual rooms to perform a pelvic exam. 

"So, eye pain?" I asked, with some intonnation that I knew about her other issue.

"Uh, yeah." She looked me up and down.  I was probably only about eight or nine years older than her.  I was also not looking particularly good.  I don't do the best job of getting dressed when the uniform is scrubs; it's like the comfort of wearing such slouchy clothing spills over into my hair and my face and I just look terrible for months.  

I introduced myself as the med student that would be taking her history and performing her exam.  I told her that an attending or resident would be supervising the pelvic and that if she had any questions, there would be someone to answer them.  I also let her know that we'd be moving to another room for more privacy.  

Once we were alone in the other room, I was surprised to hear how cheerily she reported that she wanted to get tested for STDs [sic].  I asked her if she had any particular concerns and she explained that she had recently suffered her first bout with genital Herpes and she wanted to get tested for "all the other ones."   I asked if she was worried that she might have something else and she shrugged, muttering that she was not all that concerned. 

"Do you use protection during sex?" I asked.

"No," she said.  Her response came quickly, was straight-faced, and unapologetic.  I am not saying I expect an apology on behalf of all health care providers, but I mean, wow.  This is one bold young woman, I thought.

"May I ask why you don't?"

"I don't know.  I never have.  And I have never gotten pregnant.  I don't think I can get pregnant.  But now I got these warts and I'm all like, damn.  Maybe I should get tested."

There were so many things that I wanted to address in what she said.  I chose to ask another question first.

"Do you use any kind of birth control?"

"No, and I ain't never been pregnant." 

She confirmed my worst suspicion.  By her history, this young woman had been sexually active for about five years.  She has had numerous partners and has never used condoms.  The possibilities that ran through my head were chilling.  Is this really the first time she's been tested?  EVER?!  What if she has some advanced cervical change?! Does she truly believe she can't get pregnant?  Why did her primary care doc not address these issues?  All the while I am trying not to let my face convey my fears.

"I know you have probably been told this," I said, "but you're taking some pretty big risks by not using protection.  I am concerned about a number of things.  First, you can get pregnant.  Unless you were born without a uterus and ovaries, you can definitely get pregnant--there's a first time for everything.  If you don't feel like now is the right time to have a baby, you should really think about some kind of long-term contraceptive.  Second, having unprotected sex--the kind without a condom--is putting your health at risk.  HIV rates are growing for young women in Detroit, and herpes, Chlamydia, and gonorrhea aren't going anywhere.  Has anyone talked to you about the Gardasil shot?"

"No, what's that?"

"It's a vaccine, kind of like the ones you get when you are a kid, that protects against the four most common strains of HPV--two that cause warts, and two that can lead to cervical cancer.  It's like my favorite vaccine ever!"

She laughed and looked pensive.  We performed the exam, which was pretty painful for her due to her herpes induced neuropathic pain.  Though the outbreak was waning, it was still quite evident.  In addition, she had some yellow discharge that looked more pathologic than physiologic.  We ran all the necessary tests, the attending put in his two cents, and he left the room.

I was about to leave to, but as I reached the door she said: "What do it mean?"

"What does what mean?" I asked.

"Herpes.  Like what do that mean.  Is it gone now?"

Her doctor hadn't bothered explaining anything about her disease to her.  He just gave her the acyclovir and sent her on her way.  We talked for a long time.  She had so many questions--it was as if she had been waiting for someone to talk to her about her body.  We talked about a bunch of STIs, her risks, the rise of HIV in Detroit, how these diseases are transmitted and why women are more vulnerable.  I asked her if she had ever asked a man to use a condom, and she admitted that she had not.  When she was younger she just wanted someone to show her affection, and sex ended up being a way to fill that space in her heart.  Unfortunately, these encounters had only lead to unhealthy relationships with most of the men she'd been with. 

Eventually, a nurse knocked and gave me a look that said, "what is taking so long?"  I had kind of forgotten that we were in the ER.  I had reverted to my primary care persona, taking too much time.

It was a really revitalizing conversation though.  In light of having matched it made me so happy that I would have the chance to be a family doc. 

Oh yeah, I matched!  Not only did I match, I matched into my first choice, a Family Medicine/Psychiatry residency in Pennsylvania.  It's a dream.  I will be able to ride that line I love so much.  Jess is relieved that we are going to her city of choice--she loved it when we visited during interview season.  I am still having to remind myself that it's actually happening!  We're going to look for houses in a few weeks.  WHOA!