Another systems course down; four more to go. The cardio/resp exam has come and gone and I actually did remarkably well. (The preceding sentence is meant to portray shock, not pride.) I am not sure where the last course got away from me but, with about 3 weeks left in the course, I started feeling like the heart and lungs were some sort of alien forces outside my understanding, outside my control, outside this world. Beta-blockers and agonists are my version of Jedi knights.

We have now started renal. So far I have the tubes and ions in hand, but I don't know how long that will last. I have planned my summer elective in Nepal over our exam rewrites (unavoidable given our schedule) so I have to pass this next course. Hopefully that will keep me motivated. My husband has managed to get 4 weeks off during his busiest time so he can join me. So if I fail and wreck all my plans I am also wrecking his plans for the only major vacation we will be able to have together for the next many years.

Seems hard to believe that we will be off to clerkship in less than a year. The fact that I may be responsible for patients' care is not causing me as much stress as the fact that I have made no progress towards choosing a specialty. Just about everything we have taken so far has interested me. I try to count this a positive because I think I could be happy in many different areas. But it is not helping to narrow things down.

Two days away from the next big test so, of course, I was looking for something to distract me. It was sunny for a few minutes this afternoon between the hail and the rain so I went for a walk. Springtime (which always comes with a few false starts around here) smells like wet clay and melting dog sh*t in my neighborhood. There is construction on just about every block so I zigzagged my way downtown past all the blockades. I guess I am getting a little nostalgic. The chances are good that we will have to move soon (most likely right around when I am going on elective to Nepal; great timing). After living here for 8 years I am going to miss the park and the restaurants and the people that I am used to seeing. It is funny that, as a teenager, I was so excited to move away from my small hometown to 'the big city' so that I wouldn't be constantly surrounded by the same people. After more than an decade in the 'big city' I find it comforting that I keep running into all the same people. I see the the people that I know from folk fest volunteering at concerts, neighbors at the coffee shop and people from school downtown. I even know who the regular panhandlers and prostitutes are and who is new to town. I guess it is home.

I spent the morning looking at hearts in the anatomy lab. I was again struck by the paradoxes of the human body. It is so beautiful and intricate and at the same time so crude and mechanical. It is the same thing with disease. I have seen patients with metastatic cancer throughout their body. All the organs invaded, slowly shutting down but still hanging on, sustaining life. And then the next person will have a clot travel to one particular sensitive spot or have a plaque in their heart rupture and they die suddenly, without any warning. I guess that explains why medicine can be so fascinating and gross at the same time.