The Green Me

Today is the last time I will post the end of year musing as a resident.  Next year this time I will be 6 months into my new job.  Not a resident anymore.  This is like growing up all over again and it is exciting and scary.  Last two months of my absence have been pretty eventful.  I finally achieved Nirvana and by that I mean that my 4th year has set into lower gear and cruise control.  Of course PRITE is over forever and from this despair that started this blog, to this less desperate slightly happier mention of scores, to a complete absence of any update on scores this year, things have certainly changed for the better.  In honor of my original post, let me just say that, I did really well this year.  I have moved from the lower ranks to top 5 scores in the program.  I think that is enough said about the dearly departed.

I can finally read, have time to see patients as often as I need to and have taken more therapy cases.  It's actually really fun to be a 4th year.  I completely agree with myself about what I said here regarding transition pattern in my posts.  Clearly I know myself, Yippee!!!

This gives me perspective about my anxiety with change.  When I get anxious and feel pressed for space and time, it means I will eventually get over it and on top of it.  This shall pass too, never sounded more relevant than in the past 3.5 years.  I look at the new interns and nostalgically remember my green, struggling self as an intern.  It seemed like it will never end but it did.  I remember the weekend calls and pager beeping, inpatient grind and off campus rotations with early am rounding with coffee in hand.  Part of me misses that intern because of how protected I really was and never realized it, until after the fact.

Then came second year and being the chief.  Again another green year because I was the "chosen one", the one with the invisible cloak etc., etc., etc.  I had to grow up faster than others and at times had to do it alone.  Being the oldest in my family, it just felt natural to me; until I wasn't the chief anymore this year and actually got to have less responsibility.  It is nice.  Part of me misses that green chief as well because of how she reshaped the more pedantic parts of herself/me and I never realized it, again until after the fact.

My 3rd year came and yet I was green once again, out patient!!  "I got this." I told myself when I started 3rd year, even though I had no idea what I was doing.  I knew I loved therapy and boy did I push myself.  At one point, I had 15 regular therapy patients and I was pressed for time in supervision to get consultation on all of them.  The best part of having a heavy therapy load was the decision to have my own therapy done.  I went through ups and downs of 3rd year, hanging on to my soft place to land namely, my therapy and my supervision plus my own office because let's just face it, frame matters.  I sat through sessions, my own and my patient's.  My emotions ranging from confusion to clarity, annoyance to enjoyment, sadness to happiness, anger to delight, scared to bold and then there were times when there used to be nothing.  At times, I miss that brand new 3rd year resident trying to be a therapist, because of how she pushed herself despite her doubts and stuck with it.  I just didn't realize it, until she wasn't there anymore.

So here I am, only 6 months left to graduate and knowing what I will be doing after graduation.  As I look back at years in my training, at every point, I see a part of me that had doubts, frustrations, anxiety, joys and changes, yet I was unaware of those at the time.  Sometimes things seemed impossible and sometimes it felt like an uphill battle that wouldn't let up.  But now I know that underneath it all, there always was a soft warmth of assurance and a sense of belief in what I did everyday; otherwise residency can be quite a jading experience.  Those of us who can hang on to that warmth and belief in our capacity to go beyond just "what is needed", tend to come out of this experience changed for the good.

We enter as interns but in order for us to be able to be on our own, grow up and do the job we signed up for; we have to accept the residency as a privilege and not a right.  Rights make people entitled, privileges make us humble.  Rights can be taken forgranted, privileges keep us on our toes.  Those of us who can admire that privilege in it's entirety, eventually come out better on the other side and that is my firm belief.

So as I say good bye to 2015 and wave in 2016, I hope to remember to be kind to my next green self in 6 months and take lessons from every past green part of me through these years.  I always come out better on the other side as long as I can keep my feet on the ground and head in the job.

So I will close with this,

“Drink from the well of yourself and begin again” — Charles Bukowski, (Author)

Happy new year everyone!!!

What Doesn't Meet the Eye

I am slowly waking up from my post PRITE coma and starting to feel somewhat excited about this year.  I have 3 weeks left between finishing my child rotation and starting elective months.  Here comes the planning for job search and graduation leading into board exam.  I have an elaborate plan in my mind about how I want to spend these last 8.5 months of my residency.  We shall see if I can execute the plan.

I am in the 2nd month of our year long psychoanalytical course that is offered through our local psychoanalytical society and is mandatory for our 4th year residents.  The course consists of organized schedule that takes one through the history and progression of theories in psychoanalysis, from Freud to modern day, along with clinical case presentations which by far, are the richest part of this course.

During today's class we discussed Sophocles's Oedipus Rex and then came the Sphinx and the riddle part.  Somewhere in between listening to the story and trying to stay with it, my mind wandered to the Netflix episode of The Adventure of Puss in Boots.  Odd and a little off the charts, don't you think?  Clearly it is a little too soon for me to be back on my normal schedule after PRITE.  But there is a very good explanation.

You see, the episode I thought about; depicts the Sphinx, the riddle and the Puss in Boots, who has to answer the riddle to get the hour glass or all of the town's children would die.  My kids laugh uncontrollably every time the Sphinx spits out a riddle in her valley girl accent and the Puss in Boots truly has no business being there because he can't guess worth a dime to save his own life, let alone save the town.  But how did I miss it?  The sphinx, the riddle, the cat.  This seemingly funny and witty sphinx is not a story book character for children but Sophocles's Sphinx from Oedipus Rex.  But what would that makes the Puss then?  I am sure there is something there, I just don't know what.  It was in this class today that I realized the connection between the animated TV and the old play that remains the major source of debate, inspiration, opinions, theories and clinical work to this day.

In his book Bruno Bettelheim talks about how most of Freud's work has been misunderstood and lost in translation when his German work is translated in English particularly and goes to great lengths to debunk the strongly held beliefs about Freud and his theories and particularly Oedipal Complex.  Though Bettelheim has a fair share of his critics and has been portrayed pretty harshly by his critics about his work and his views, but above and beyond all those; I think he makes the seemingly hard to digest Oedipal conflict very natural and human to all of us when he explains it's applications to the psychotherapy and our own personal growth.

His explanations of fairy tales like Cinderella and Beauty and the Beast or The Little Red Riding Hood are an interesting way of looking at the world of enchantment given that he was a child psychologist.  His explanation of Cinderella in the context of sibling rivalry and a child's natural desperation in the face of one of the biggest calamities of childhood "loss of love" i.e. birth of another sibling or presence of another sibling means having to share the object of love mother/father (according to Freud's Calamities of childhood) makes it clear why we from very young age tend to be fascinated by the stories of witches and princesses and knights in shining armors.  Because these fairy tales serve as a safe and benign way of satisfying our unacceptable (to self or others) feelings, wishes and fantasies.

His description of Little Red Riding hood and the Big Bad Wolf is not very well received but anyone who has seen the play or the movie Into the Woods knows that the Big Bad Wolf doesn't want to simply eat the Little Red Riding Hood.  The children storybooks are merely a more tolerable container for what we can't contain in ourselves when we are younger or don't want to face in it's raw, volatile reality when we grow older and become parents ourselves.

Ever since I started reading more and opening my mind to the ideas of psychoanalysis and psychodynamic theories, I have been fascinated by how children actually really do exhibit what Freud had described so many years ago.  If I have ever seen a young child go through the Freud's phases, it has to be my own son (he is my only window into a little boy's mind; who is growing up in what I hope is a healthy environment).  He has gone through an age of being totally dependent on me and his dad for everything as an infant to being a 2.5-3 year old who used to scream at the mere sight of his dad when he was crying for me and I was on call away from home.  He then developed into a 4-5 year old, who clearly was in direct competition with his dad for my attention and in his own boyish way would protest and show his anguish, if he disapproved of his dad sitting a little too close to me for his liking.  He gradually started to give his dad more attention at around 5.5 to 6 years of age and then grew out of his competition with his dad.  He went from telling me that he will be marrying me when he grows up to saying that he will find a girl like me and marry her.  He has attained developmentally appropriate resolution of conflicts necessary for a 7 year old per Freud.  It has led to him eventually accepting that his mother and father are separate entities than him and he cannot compete with his father, nor his father is in direct competition with him.  All of this has happened because he has been provided with a consistent and developmentally appropriate hierarchy in the family unit and hasn't been pathologically triangulated in neglect or overindulgence that leads to pathology due to conflict in Freudian stages.

Of interest is the sibling rivalry that I have seen among my children and has been verbalized by my daughter, who was merely 2.5 when her brother was born.  A child who you may think won't remember much but is somehow able to tell her brother that if they had another sibling; he would feel how she felt when he came along and took "mom's love" from her, and then he would know what she felt like.   Amazing that a child this young remembers 8 years after her brother was born, what she was going through and holds him accountable for her distress.  Her aggression towards him as a rival probably serves a function of feeling powerful over him as an older sibling and a way to be determined to never feel what she felt when he was born.  She very well may have guilt for feeling the rage, she probably isn't even aware of it and the mind doesn't want to acknowledge it either, since you are supposed to love your family.  She is able to process these feelings without feeling threatened by them because she has learned that she is allowed to have those feelings, along with caring and loving feelings her brother and that she won't be told by her mother or father that she shouldn't have those feelings towards her brother.

More on guilt and shame in a future post when I will talk about Alice Miller's work.

We all hope to raise children who will pass through all the stages of their psyche with appropriate conflict or at least minimal unresolved conflict.  We can be sure that as long as mothers and fathers we don't impose our own unresolved conflicts onto our children and allow children to be their true selves with their emotions and feelings, we will end up raising intact human beings.  We can be the containers we are meant to be for our children and not the other way around because it is not their job to contain us.

Because fairy tales are not fairy tales if there are no happy endings.  There is always more than what meets the eye and what doesn't meet the eye can make a difference between a nightmare and a dream for a child.   

Tales From the Other Side

Seems like I tend to zone out for a few months when I transition.  As always I have a perfectly good reason.  I got busy and guess what it's September, yet AGAIN!!  Now I don't need to remind you what this means, do I?  I am sure my PRITE post from last September can help.  Yes it's here again.  I am clearly in panic as this year so far I haven't had any chance to study at all.  Serves me right.  I mean what was I thinking procrastinating until July and hoping that being a PGY-4 will somehow make me invincible and give me unlimited amount of time to study right from July.  Being a PGY-4 is challenging and so far mostly a constant whirlwind.  Running from one place to another and not having an office anymore basically is the life right now.  It's busy and at times quite draining when it leaves no time to actually sit down and study or read.  I do have a light at the end of this tunnel in about two months when I can start my elective months and have more flexibility in my schedule but until then it's the hamster wheel, only much more bigger and my feet get stuck almost every day.

This is my last transition while in residency and change is always hard.  Being in my own office for a whole year was something I got used to and used to look forward to.  It was a feeling of being at a home base which is gone now and in so many ways may be is appropriate because I need to move on in about 9 more months so I can't get too comfortable.  May be that is the natural course of things.  I will probably feel much better as I get to the month of starting my electives and take a breather.

I have looked over my posts from last few years ever since I started writing here and see that every transition brings feelings of being overwhelmed, annoyed and at times pure frustration but it also helped me see that eventually I start feeling like I have grip on things finally.  I am hoping it will happen soon.  In the mean while I have to study for my in service exam so I can move on to bigger and better things like studying for the boards, which sounds oh so pleasant, NOT!!

I would like to come up here and write some about a few great books I have read over the last 2 months of absence but I need to be in a zen mind set to review these books.  I think my zen will come after my in service which is in time with the end of my child rotation which starts in 2 days.
I will peek back in next month to see if I can produce something worth reading but for those of you who read this blog (and it amazes me that so many people read this from all over the world) I will say this much; first rule of being a psychiatrist, be in touch with your inner self and take care of yourself before anything else, (at least for me).  So my absence here is not out of a memory lapse but only out of the survival mode I am right now.

Until the storm calms down a little, hang in there with me because the other side is kicking my behind so to speak and it is going to take a while to start thinking more clearly.  

Final Chapter

I just completed the seemingly mundane task of updating my signature for my work email on my iPhone.  For many this may be an unnecessary task or a head scratcher as in "what?" or "you have a signature in your email?"  For me however, it's not.  My email always has a proper intro and a formal ending with of course what else but my always up to date signature.

Today is the last day of my 3rd year of residency training.  End of so far the fastest year of my residency.  I am slightly shocked by how fast this year has gone by and now as of tomorrow I am a PGY-4.  Next year on this day I will finally be done with my training.  So many emotions go through my head when I think of where this year is headed.  I think I don't want to think about it for a few months.

My signature update included changing my PGY-3 designation to PGY-4 and most importantly removing the "Psychiatry Chief Resident" title from the body.  It was a mix of nostalgia, sadness and slight sense of relief.  I am not the chief anymore.

I won't be getting dozens of emails about millions of different little things that I used to do from schedules (until I did them) to class schedules, to putting out little fires here and there, to big things that happen in every group that has 20 different adults of various ages and personalities, to many emails that I had to write to ask for this or that to be done.  I am not doing the orientation this year nor am I responsible for anything else chief residents have to do.  I mean there is no set job description as is and yup still no magic wand.  While I feel like I will miss the daily churn and the feeling of being needed that came with the job, it is probably going to be pretty nice to have a relaxing final year of training and being back in the middle of the group in the meetings rather than at the front of the room.

It is going to be a big adjustment because at this point I have more time as a chief in the program than just being a resident.  I am fully aware of this transition and that it will be a bit of struggle for me because I have a tendency to try to handle things when they present or take upon myself projects to handle things I think need handling.  My title gave me enough autonomy to do so while I was in the role, like figuring out patient hand off between incoming and out going residents or taking on updating our website or changing the ER rotation structure when I felt like it needed changing.  That is a place from where I have to mindfully step back and let the newbies get their feet wet and make their own mistakes and take up their own projects.

If I had a chance to do it all over again, I would probably do it despite of the frustrations and stresses and extra work it gave me.  These past two years also gave me a lot of experience to look back on and learn from my mistakes.  I am sure because of these two years I really want to think about what do I want from my life after this year is over.

I am finally ready to let the responsibility go and enjoy what is left of my residency training.  In the end as I edited my signature today to take my place back in the middle of the group, I realized that sometimes the seemingly little or mundane acts like hitting the backspace and delete keys are all it takes to take a load off and put up your feet.  Of course, it helps that now I am officially allowed to do so.
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As some one once said "Don't close the book, just turn the page."  so here I am and I think the final chapter is going to be the most exciting.  

Tis' the season to be Jolly!

Here it is again.  It seems just like yesterday when presents were given and parties were thrown, families got together and emotions were mixed.  Time sure flies when you are having fun.
Sounds like Christmas and for the graduates from all walks of life, it might as well be.  The diplomas that are handed to these graduates all over the U.S. are like the Christmas present you get from your grandparents and you know what is in it because you told them a thousand times what you wanted but now you aren't sure you picked the right present or worst would you be able to use the present as intended?

I have come to love the graduation season almost as much as Christmas because well really what's not to love?  It's not cold and there are flowers (unless you have allergies and then it sucks), sunshine, Facebook feed with a slew of gleaming pictures with grads and their proud families; and best of all Target and Home Goods have stellar sales for the grads.  I mean come on now, who doesn't like a good sale any time of the year?

Just like other academic settings this is also the time of the year when medical students, senior residents and fellows are graduating and other residents are moving up the PGY ladder.  What a great time!  I am going to be a 4th year in about 3 weeks.  When I started writing this blog I was in the middle of my 2nd year of training and here I am now finishing my 3rd year and being the senior most upper level resident.

I am graduating from PGY-3 to 4.  There is a virtual party in my head 24/7.  Well in the background at least.  It also is the last year of my training and I find myself getting sad at times thinking about losing the comfort cushion my program has provided me.

I call my program "The mothership" when I am on an away rotation and all of us have pretty much adopted that term.  Just like a mother, it provokes loving and secure feelings in us; while at the same time we have conflicting feelings towards it, making it what the Kleinians refer to as the bad object.  I have another year left at the mothership before it ejects me in the outer space to navigate on my own.  Talk about anxiety.

There is also the transition of the patients I have seen for a whole year and have formed relationships with.  It has been a hard transition for many reasons.  Some patients I wish I could keep but I am capped and some patients I have struggled with myself.  To find a new resident, that I feel may fit them or vice versa; has been a challenge.  Hand offs in residencies are not well organized for the most part and with mental health patients it can be even more sensitive and chaotic esp. for the patients.

This is also the year I will step down from my position as a Chief Resident for the past two years.  This has been one of the most challenging roles I have played during the residency and I say this with a five year supervisory role prior to starting residency.  Being a chief in a residency program is nothing like being a supervisor.  This is a position of a certain perceived power where depending on your PGY ladder position in the program; you may have peers, juniors and seniors to manage and think about.  I have learned of my weaknesses and strengths and I have made mistakes and done good things for us as a group and hopefully for the program.  The best lesson I have actually reaffirmed for myself is that as long as you do the right thing, and as long as you are willing to step back to look at yourself and your peers critically; you will do okay.

People are generally reasonable if you are fair and honest and by that I mean that you can sleep at night knowing that there is no nagging little voice tugging away at you from somewhere deep inside.  Because your only job at all times, whether you are a chief or not; is to take note of that little voice that we like to call the superego.

So here I am in the last stretch of my chief time and PGY-3, passing the hat on to the next chiefs; and passing a lot of patients to incoming PGY-3.

Next year it will be my time to graduate as we bid farewell to our current PGY 4s next week.

As the lyrics go:

As we go on
We remember
All the times we
Had together
And as our lives change
Come whatever
We will still be
Friends Forever

So if we get the big jobs
And we make the big money
When we look back now
Will our jokes still be funny?
Will we still remember everything we learned in school?
Still be trying to break every single rule
Will little brainy Bobby be the stockbroker man?
Can Heather find a job that won't interfere with her tan?
I keep, keep thinking that it's not goodbye
Keep on thinking it's a time to fly and this is how it feels.      

"Graduation by Vit C."

A Word Less Spoken - Grief !

C.S. Lewis said "No one ever told me that grief felt so like fear."

I see patients every day who are sad, anxious or angry but hardly anyone ever mentions grief, fear, being scared or being afraid.  I don't seem to get those emotions out easily from them, hence many of them remain unaware of their grief and the fear that comes with it.

Grief is tricky, grief is sneaky and grief is scary.  I say it is tricky and sneaky because we generally don't think of grief when we see people for therapy.  The most common feelings we hear are sad or anxious.  I tend to think there is always grief that lurks in the corners of their minds, sometimes obvious, mostly not.  Rage and anger to me are directly proportional to the grief people carry around.

Children need security of consistency, affection, love and care to thrive and become self sufficient, adequately attached adults.  No matter what your inclination is theory wise, an overwhelming majority of professionals do believe in importance of the early year bonds we as humans need.  When these bonds are dysfunctional or absent a perfect storm simmers.  How unfortunate it would be to come to this world and question the reason for being here not because of pure existential concerns but because no one ever made a big deal about you being here?  I wonder how many of us can relate to this feeling conveyed by any number of patients?  

My guess; probably most.  

I always wonder about the people growing up with feeling unwanted, unloved, uncared for or all of the above.  How it shapes them and their relationships?  What is it like to live in a perpetual state of being irrelevant?  It makes people angry, sad, enraged, anxious, worried, doubtful and so on and so forth.  But come to think of it, would all of these feelings not be linked to the feeling of grief?  

Grief for not having what seems so natural and right for us to have when we are born.  It's the sort of grief that lies so deep and is so intense that it almost demands to be acknowledged yet is so intolerable that it's almost always ignored because how can you grieve something you never had.  

But why can't you grieve not having something at all?  Wouldn't deprivation lead to indulgence but without gratification?  Adults with early attachment challenges mostly keep looking for what they never got.  Sometimes in form of one after another dysfunctional relationship, sometimes in substance use and many times in both ways.  The early age deprivations drive people to indulge in relationships with people and/or drugs in such self destructive ways but seldom result in gratification of what they need.  A bottomless pit of despair that always seem to be wanting more.  

I wonder if the grief of deprivation is so immense and scary that people can't seem to face it?  It must be very scary to never know what is it like to trust that one is worth anything.  It must be terrifying to ever think that your being in this world would ever matter to someone else.  May be it's the fear that realizing one's grief would mean staring the deepest darkest moments of despair in their face while at the same time acknowledging the hard work that it will take to own it and learn to live with it.  Grief isn't like sadness because sadness fades away but grief never leaves.  It etches permanently and it always have fear close by.  

To live with grief is to live with fear but to not respect and acknowledge grief; is to live in a constant storm that always simmer, is consuming and unpredictable because the more it is denied, the stronger and scarier it becomes.  

As C.S. Lewis says it's a process not a state, 


“I thought I could describe a state; make a map of sorrow. Sorrow, however, turns out to be not a state but a process.” 

The Couch Reversed

After a long absence I am back.  I have a few thoughts about what made it possible for me to come back today.  Last few months have been a whirlwind for me to concentrate on this blog and muse much.  I don't think there are enough hours in the day to contain what goes in my life on any given day.  I am nearing the end of my 3rd year and it is only 3 months away.  Hard to believe I started here midway through second year.  I have bad days and I have good days.

I worry about my impending cord severing in 17 months to be on my own and it scares me to think I will be on my own.  One would think moonlighting is a good practice to run solo but I still have options to consult, mainly because I am probably quite lucky to have that option.  I am losing one of the best times of my life at the end of these 17 months and I feel like I want to grieve at times.  I am sure, I am starting to.

One of the best things I have done for myself over the last 2 months is exactly what the title of this post says.

Have you figured it out yet?

And if you thought of therapy; you are the winner.  You are pretty awesome at this guessing game.  

So after 8 months of monkeying around this idea of getting in therapy for myself, I finally gave in.  The proverbial couch is literally reversed.  It is quite a transformation and one that I never knew would make me think so much.  

For many psychiatry residents, esp. if they are like me and see or want to see a lot more therapy patients, it is something that just has to be done.  I hope all programs provide supervisors for therapy cases, as they should but I also hope that many psychiatry residents do not end up ignoring the need for their own work to be done.  If you have a supervisor that is open to working simultaneously with you and on you, that is great.  My supervisor on other hand never had a choice and mainly because of me.  I am used to taking charge and in my mind, I had this one hr a week for case consultation, so I would walk in and use every minute of that hour for my patients.  He got to get glimpses in my personality but by the time I brought up the question of my own work with him, I already had a mindset that this is an hour paid by my program and I shouldn't use it for myself.  Not to mention I had 8 cases for therapy and at times 10-15, so I needed this hour more than ever.  

I started noticing my anxiety as a therapist get louder, the more intense therapy with my patients got.  The emotions and reactions in me were what forced me to be very honest with myself about what did I want myself to be able to do when I take on people for therapy.  

I started reading more this year.  Yalom, Bowlby, Beck, Wachtel, Gabbard, Robert Karen and numerous articles here and there.  None of these people that I admire so much and learn so much from, got so good at what they do without having their own work done.  

I want to be half as good as any of them.  That is what I want.  So I can't ignore the need to be the patient in order to be an effective therapist.  

I finally gave in and asked my supervisor to be my therapist.  That in itself was an intense experience from having to process my need to have the safe path to therapy with a known person than to open to a totally new therapist, finding a new supervisor and then realizing I lost my supervisor relationship with my now therapist.  It was something that came so unexpected yet proved to be a great stepping stone into the new relationship.  

Now 5 weeks into it, I have started to understand why my patients, who come sit across from me in my office; keep coming every week.  I understand that they are the ones doing the work and when they ask me questions about what to do, they are not meaning to put me on spot, neither are they looking for a magic formula; but rather exactly the opposite.  They already know what they are asking me, I just help crack the code.  Sitting across from my therapist when I share things that make me question my own abilities, limitations and that frustration that I feel with myself many times; I hear myself say things I only think about but am too scared to admit to myself.  It's like I believe, as if I am superhuman or should be superhuman.  I have started to understand my worries and anxieties in ways I probably already knew.  It is so odd how actually saying them out loud is akin to giving life to something many of us like to keep buried.  Reversing the role makes me see how without this step, I was never going to be able to fully understand the person who sits across from me every week without doubting the process every step of the way; because I never had the experience from the other side.  

Dealing with my own life and facing my own limitations, I have to do it; to do what I want to do.  The proof is in this post.  Took me 2 months from my pledge to write here to actually write this.  The only thing that has changed is that now once a week I get to be the patient.  I get to be able to let it go and face myself without reservations.  Something so hard to do but has a profoundly liberating effect.  Most probably one of the reasons I am back here writing again.  

So if you are a therapist, psychiatry residents or aspiring to be either one of those, keep your work on yourself in your mind; not as an option but as a necessity.  Not because it is cliche; but because it is anything but.  

As Irvin Yalom says, 

"Self exploration should continue throughout life, including entering therapy at various stages of life."

    

New Year, New Resolution - 2015 is here!

Oh dear !! I feel like a broken record.  This was a long break but so needed.  PRITE is done and over with.  Last year it was my disgust with it that started this blog with PRITE scores are in post.  This year I am not as disgusted.  I think it was the last part of my post that kept me going and ah money of course.  What do you know, as a fully licensed resident I do get to moonlight now and my in-service performance makes or breaks my bank.  Talk about motivation.  It worked.

I think my resolution this year is going to be to give myself time to think and actually write here.  It has been a great release writing my thoughts here and I feel that it does good things for my processing of events and emotions.  Six more months till I move on to a 4th year.  It is going to be intense.  Things I want to write about are match/interview do's and don'ts from two years of being through this process, looking back at my chief role for two years, moving on to last year of residency and the new experience of moonlighting and of course I am reading more and more, so may be a few posts about some insight from readings.

So with this post I commit to thee, my musings.  Happy writing to me.