vintage scutmonkey: psych

OK, I think this is the last of this throwback series. It also happens to be the first "Scutmonkey" comic I wrote (even before "The Twelve Types of Med Students," even*), and I finished it about a month before I graduated from med school. It seems that the Wayback Machine doesn't archive every last image in a deep side branch of your main blog, which is why half the panels are kind of greyscale and janky (photos of a photocopy, you know). But hopefully it's all still legible.

Two small points. One is that I think it's not necessarily the kind of topic I'd write about so freely now, because, you know, mental health awareness is important and sensitive and all that. But for what it's worth, every single patient interaction or expressed delusion in this comic was absolutely true, almost to the word (if somewhat condensed in certain cases). Actually, all of it is true, right down to what people wore. (I was mesmerized by the chunky pendants and flowing tops my course director wore and therefore studied them in great depth before drawing them...badly.)

Second point. The building we used to refer to as the "old Psych Institute," shown in the first and last panel of the comic, is now the School of Public Health at Columbia. It's the exact same building--it even still reads "Psychiatric Institute" in the carved stone arch over the door--but, you know, they put up a new sign at eye level. So the one part of this comic that's not true is that I never went back. I am back, and the location seems like a tiny bit of poetic justice.

* Edited to add: I was wrong. I looked at the dates and I finished "The Twelve Types of Medical Students" 2 days before I finished this one. I had likely started this one first, though, because, you know, it took longer.

back in the saddle again

So here's the thing about going back to school when you really haven't been in the classroom for the past...oh, let's say 16 years. (I am lopping off the last two years of med school in this calculation, since that was really more clinical than didactic, and really more indentured servitude than clinical.)

First of all, I can't remember the last time I've had to sit still for as long as I was in class over the course of the last weekend. And I'm old! Sitting still should be my default state at this point, and as I get older I expect I'll get increasingly horizontal until finally, I'm dead. (Meanwhile, also because old: reminiscing/bitching about how the good old days were better than this all bullshit.)

Second: I am trapped in amber. School is different now. I see it with my kids (Cal in particular has a particularly robust online curriculum in middle school, and he'll usually get all his homework assignments to complete and hand in online, or complete group projects via Google Hangout and the like), but I am a traditionalist. I don't like to consume didactic material on a screen. I need to read on paper. I need to write notes with a pen. I like touching things. Consuming information of a certain sort on line is like trying to eat after contracting cholera--it all just goes right through me. I don't know if it's simply a matter of preference or motor processing or what, but after a few half-hearted attempts at reading online, I just had to print out all my course materials from online and keep it in a binder, which I had to do at home because Columbia refused to do it for us, citing a grand school philosophy of environmental awareness and conservation. (My take? Fuck you, trees. Get in my printer.)

Third: There are a lot of words I haven't had to apply to myself personally in a while, and it feels weird to say them. I have "homework" to do. I have "problem sets." There are "papers" to write and "finals" to take. I have to locate and use a "pencil."

So in sum, this is all very different and disorienting and it's a lot of work.

I kind of love it.

Carry on.

P.S. Oh yes, many of you have told me that my page has been loading slowly and crashing with some frequency. So first, disclaimer: I don't actually know how computers work anymore, so this might be a bit of a process to fix. But second, I tried to streamline a few things on the sidebar that I think were causing problems (I suspect the Tumblr code widget was going Skynet), so if this has helped, or if it's all still exactly the same degree of shittiness, let me know, and for what it's worth I will tinker some more.

office space

That face when you realize that instead of having one written assignment due for your Healthcare Management class on Thursday, you actually have three written assignments due.

Where do you find a place to do work? I've always had trouble really getting work done at home. Always. It's not a matter of not having enough space. I have space. Physical space, I mean. We even have a room designated as an "office," though in recent years there has been some creep as one kid or two have gradually taken over my desk to use my computer for this that or the other thing. But it doesn't even really matter--even with the separate room, and even with the door closed, and indeed, even when no one is home but me, I find it very distracting to work at home. There's just too much else to do. I could do my work, or I could put another load of laundry in. Or clean up the living room. Or start prepping dinner. Or let the dogs out. Or let the dogs in. And hmm, this keyboard seems awfully dusty. (Smash cut to a 30 minute quest to find that one compressed air blower thingy that I'm sure I saw coming out of a box when we first moved here more than three years ago.) And on and on. So it's not so much a matter of finding the space, you see. It's just a matter of finding the correct sensory deprivation tank.

My go-to for the past decade-plus has always been to go to a Starbucks. Starbuckseseseses are generic and neutral enough, and if you bring headphones, reasonably quiet. (Though I did memorize the entire Beck "Mutations" album in med school against my will because apparently that's all they ever played at that Starbucks on 103rd and Broadway while I was studying for Step 1 of the Boards. "It's nobody's fault, nobody's fault, but my oooooown.")

My only real problem with Starbucks is...well, there are two problems. One is that you kind of have to pay to be there. It's not a rule, of course, but what kind of ass parks themselves in a coffeeshop for hours without buying something? So that's four or five bucks right there. (Sometimes, when I would really stay there all damn day, as I did during med school to study, or in residency while writing my book, I would buy a drink in addition to the cheapest real food item possible, which was usually an egg salad sandwich. I...don't like egg salad sandwiches that much anymore.)

But the issue of rent is to be expected. My real problem was more of a sensory one. I have headphones, I stay in the corner, I don't lollygag at what other people are doing. But the smell. I don't know if they have a roaster on site, or if that's just the smell of coffee itself brewing, but if you sit in a Starbucks for a few hours, you're going to smell like you just walked out of a bonfire. Everything. Your hair, your clothes, your skin, the inside of your nose. You smell like an arsonist. You smell like you just finished smoking four packs of cigarettes.

Anyway, I know this is, like, the most obvious solution in the world, but today I tried something new.

The library. I know, duh. THE LIBRARY. This was a nice library! So quiet! Such beautiful natural light! Such a delicious old book smell when you walk in the door! So close to my house! So free!

I don't know why I'd ruled this option out in the past, but I've had several formative bad experiences trying to get real work done in a library. In med school, people would get weirdly territorial about their study spaces, and I would leave all their stuff by choice carrels or tables (and I mean STUFF--not just books, but changes of socks, full meals, honest to god desk lamps that they toted in from home) and their general gunnerishness turned me off. (Sorry, fellow med students. You're great, but recognize that there was a point in our career development where we were all borderline intolerable.) As for my regular neighborhood public library, this may have just been my area in New York, but our local branch library was more a place where pleasantly demented seniors would come read all the newspapers on Earth (licking their fingers before turning each page, which is something they somehow managed to do loudly), and where homeless dudes would come in out of the cold and wash up in the bathrooms. Which is fine, but maybe just not the ideal space to try to do some hard core memorization. Or even soft core memorization. Or barely legal memorization. Because I would get really interested in the side stories. Like: how many newspapers can you read in one day? Did you bring them into the library from home? What's the point of reading a two year-old newspaper cover to cover? I HAVE QUESTIONS.

Are you able to work at home? How do you do it? Do you have kids? Don't they always want to talk to you? How do you minimize distraction? How do you carve out the mental space for this work but not that work? These are things that I'm going to need to start to address more, once I start having to do more school work after hours, in the margins of my day. But when I'm able to use it, the library is going to be a nice option.

back to school

I've enjoyed seeing everyone's back to school photos of social media these past few weeks, though they make me realize that I must be either one click off age-wise or else totally disconnected from current parenting trends, as I have never in my life taken a picture of my kid holding a sign (or if you want to get real fancy, a blackboard) broadcasting what grade they were going into. (Another trend that either came later or else that I just totally ignored was that thing where you put a giant sticker on the front of your kids' onesie telling everyone how many months old they are.) I mean, not that I don't take a picture of my kids on approximately the first day of school, because I do...kind of. But it just seems like there are so many things and rituals and accoutrement now. Like the child-rearing industry is slowly becoming the bridal industry.

But speaking of back to school...

Around the end of last year (right around, oh, say...Wednesday November 9th), I started thinking about how I could get more involved in healthcare on a broader level. I love my job and have no plans to stop being an anesthesiologist, but I also wanted to do something...else. Something more. Something less zoomed in, something a little more macro, something more policy and population-based. A broader way to help out. So what I decided to do was to go back to school and get a Masters of Public Health.

This was not an easy decision. Getting this degree is going to take a lot of time. It comes with a not-inconsequential monetary cost. I don't "need" to do it, and in most ways it's going to make my life a lot harder. It's not linked to any particular path for upward mobility or higher earning power, and I'm not looking to switch jobs. Almost no one that I'm close to understands why I want to do this, or thinks its remotely a good idea. (My parents seemed initially excited at the news, but then rapidly realized that I said I was getting an MPH, not an MBA, as they misheard. They were much less excited after that.) Oh, and also, I don't really have a really good specific idea of what exactly I want to do with this degree when (or if) I finally complete it. If I'm going to be totally honest, the only real reason I want to go back to school is because I want to learn more about public health, and can only hope that in the process of going through the coursework I'm going to find a useful, real-life way to marry this knowledge with my current career and find a good, real-world application for it. But I don't know what that's going to look like yet.

So anyway, that's happening. I've been accepted to the Mailman School of Public Health at Columbia, and will be starting their part-time executive MPH program next week. "Part-time" means I still will working my normal job, exactly the same as before. It also means a lot of remote work and an online curriculum, though once a month, for one long weekend (Thursday through Sunday, all day long), I will be flying into New York and completing my in-person classroom requirement. This, every month, for two years. We had an on-campus orientation in August. The first official day of classes is next week on September 14th. If I can get through this all without losing my mind, I'll be slated to graduate in August of 2019.

The time investment. The time investment is...a lot. I take it seriously. I work part-time at the hospital, but I have three kids (which is why I went part-time in the first place), and kids don't just go on auto-pilot. Doing this program necessarily translates into less time for me for them. It means more time in the evening spent in front of books, more than twice as many weekends I will be out of the picture, less flexibility for everyone all around. This was Joe's main objection to me starting this program. I don't think I'm airing any dirty laundry by talking about this, because he'd tell you just as easily: he doesn't think this is such a great idea. He's nominally supportive, and by that I guess I just mean he would never tell me explicitly not to do it. But for our family, I know he'd really rather I just...didn't. He doesn't see why we spent so many years getting to a point where our life was finally getting easier only to deliberately make it harder again.

But that was my exact thinking, only in reverse. We have three kids. Our youngest, Nina, just started kindergarten this year. I'm not saying our kids still aren't youngish (they are), or that they don't need me as much (they do, though the ways in which they need me are less about immediate survival and more about presence and guidance and...well, I guess I do all the food shopping and cooking, so, yes, maybe a little bit of survival). But it's a bit easier now. We have some breathing room. We have margins. What do you do with that elasticity? What else do you want to do? What's important to you? Is it about the luxury of empty space, or is it about the luxury to take on more? To do more with your life? What comes next?

Also. I finished residency nine years ago. Nine years into private practice. I love my current job, I love taking care of patients. It's the most rewarding, immediate, and intimate type of service I could ever hope to provide. (I know I'm supposed to say, "outside of parenthood" right here, but I won't. It's not that I don't think parenthood is important, I just feel it's a completely different thing.) But I feel like there's more I want to do. I just don't know how yet, so I want to learn. Because life is not lived in order to be easy. Life is lived to be worthwhile.

And honestly, once I decided to go ahead and do this thing, part of me was really tickled and excited about the idea of going back to school. It's been a long time. And I like school. I like learning. I like knowing things. I especially like knowing things that I feel I should know already. I've been doing some pre-reading for some of my classes, and there are so many things I'm learning now--about healthcare economics, policy, the history of Medicare and Medicaid--that I can't believe I hadn't been explicitly taught before. And the fact that I'll be back at school right where I started, at Columbia, on the health science campus...I just get a kick out of returning "home." (Columbia friends: the School of Public Health is located in the old Psych Institute, next door to the new Psych Institute, two doors down from our first year prison dorm rooms in Bard Hall. That was a grim little block wasn't it?)

So anyway. That's what's new with me. How have you been doing?