You can find it in the Target parking lot

I'm in Denver again interviewing for a job at one of Denver's trauma centers and doing more work at National Jewish. I'm trying to study 140-some patients who have a cavitary form of Mycobacterium avium complex lung infection, a bacteria like TB. This bacteria slowly eats away at the lungs over years and it's thought that 10-20 people in every 100,000 may have some form of this disease. Asthma occurs in about 1000 in every 100,000 people, giving you some perspective. TB occurs in about 4 in every 100,000 in the United States. I'm having computer data problems which is slowing me down but that's not what the blog is about tonight. It's about the Target parking lot.

I'm staying at the Staybridge Suites hotel, a subsidiary of Holiday Inn, having a stove, freezer and refrigerator and a couch for my comfort. It is not quite in the suburbs but it's hard to tell. Thus when I asked about a good place to eat I was directed to Applebee's, "in the Target parking lot." When I asked at the front desk if I could work out somewhere they directed me to the 24 Hour Fitness Center in the Target parking lot, and when I wanted some Pepcid for my stomach I discovered that there was a Walgreens, yes, in the Target parking lot. There is a SuperTarget in the Target parking lot, a store that not only has the red decor and array of goodies that a normal parking lot, sorry, Target has, but also this Target has a grocery store and indeed has a HUGE parking lot. Not only is there the above establishments but there is also a sporting goods store, a KFC, a Wendys, a gun shop and a strip bar. All in the Target parking lot. Just ask the front desk.

The Target parking lot is also the hottest place in Denver, in my opinion, or the world. It is bigger than a few football fields and it's newly covered in black top making it kind of a tar pit in the 96 degree sun. There were dead people in the far regions of this lot, clasping their doggy bags from Applebee's. I saw a mirage as I was crossing to the 24 Hour Fitness and before embarking to Walgreen's I left my driver's license and contact information with the front desk for fear that I might not return. I asked my friends Tim and Ginny to inform my family if someone found me dead in the Target parking lot. I have never crossed a desert, I've just gone to get some tennis balls in the Target parking lot. "Make sure you have enough water, sir!"

Interviews through medical history.

I don't remember the interviews I had for work at Fort Snelling as a tour guide, a 7-11 store clerk, Webb Publishing where I loaded a book binder, or Economics Lab (now Ecolab) where I worked to assess the clarity of dish cleanliness from dishwashers. I do remember some of my interviews for medical positions.

First, I interviewed for medical school where I was interrogated by a radiologist and a pathologist, two specialties known for the dynamic, personality piercing individuals they draw. The radiologist was at the Minneapolis VA hospital and since I was interviewing at a time where the Vietnam War was still in the minds of America, about 1981, he asked me if I would serve if drafted. In 1980 I had registered for the draft after some soul searching, and soul bashing, with some friends, Pete and Tim, whom I travelled with in Ireland. The year of Ronald Reagan's election to President. Neither of them had to register, but I respect them anyway. My friend Bruce actually served in Vietnam, so I bow to him. It is surprising how this issue has lingered through my life, and through the lives of our generation. I had decided to register, and I told my interviewer that I would serve if I believed in the cause, including, merely, in duty to country. But I thought that I wouldn't serve for idiots, which it seemed we were asking our soldiers to do during the Vietnam era. It would have been hard to serve for W. Bush and Rumsfeld too but I might have just done it out of duty to country, I don't know. The consequences of not serving in a draft would have been significant though. Get shot at while serving under fools, or be a pussy with a record, that's what I thought. What a choice. I'm glad I didn't have to make it.

The pathologist was at the University of Minnesota Hospital. In a dusty, Ichabod Crane manor he asked me what I would do on a first date. Oh God!!! I think I told him that I would shower for once, shave, dress in my usual green polyester suit and pick up my baby in a rusty blue Plymouth Satellite of that Racing Age. Then I would listen to her make a list of entitlements that being a cute suburban woman brought. We would eat, me ordering chicken, and she ordering the most expensive dish with liquor. The guy paying all bills was part of the entitlement... and then I would bring her home. Period. I told him how fondly I remember those halcyon days. He seemed to nod off. I got into medical school anyway.

Medical school happened over four years, then it was time to interview for Transitional internships since I wanted to do internship, then go overseas to work and travel, to come back to do a residency. It was 1987.

Some highlights of the trail included going to San Francisco to see my Aunt and cousins and going to Portland where I met a couple of surgeon candidates from Seattle leaving me with a good feeling about the Seattle area medical environment, since they didn't seem like the usual surgeon candidates that I knew, they were likable. I had limited exposure to surgeons then, but over time I have come to like and admire many surgeons.

I made a trip to Chicago to see my sister Kate in Evanston. This is where I eventually ended up. After passing through Chicago on my way to Grand Rapids, MI, in rush hour traffic, it took four and a half hours to get from the North Chicago suburbs to the Indiana border, 30-40 miles.

I got to Grand Rapids where I also interviewed. After the interview I was trying to get back to my hotel while rain was coming down in sheets and it was windy. So windy that while I was trying to get onto a freeway the wind blew my windshield wipers apart. The driver's side wiper got blown so that it was ticking against the section of the car that separates the windshield from the side window...tick, tick tick...while the rain blanketed the car and the road, all while I was going 60 mph trying to get onto a freeway. Luckily a container truck, minimum eighteen wheels, was not going to yield to me, a small Chevy, maximum four wheels. I slowed down to try to sneak behind it, but ooops!-the eighteen wheeler had another trailer, two behemoth trailers, something I couldn't see through the rain and the wiper ticking against my side window and mirror. So I had to drive on the grassy hill bordering the freeway with the sheets of rain covering my windshield and the fear of the car turning over. I think I had the radio on as well; too bad cell phones didn't exist since having the phone to my ear would've added to the excitement. As I got tucked onto the freeway the rain stopped and the sun came out. Just in time to get back to the hotel for the six o'clock news. The weather was clear for the drive back to Chicago. I didn't need the windshield wipers in Michigan, on my American made car. I also went to Pittsburgh without event.

I finished a Transitional, or rotating, internship in Chicago, went to India to work, travelled through SE Asia, and returned to do residency at Hennepin County Medical Center in Minneapolis. I decided that I wanted to do a pulmonary/critical care fellowship so I hit the interview trail again, circa 1992.

I went to Boston, New York and Baltimore, where at Johns Hopkins I was told that one of the attendings had just been kidnapped and stuffed into the trunk of a car by a group of the local hooligans from the crappy neighborhood around the hospital. And this reminds me of a medical student who was killed near Cook County hospital in Chicago while she was waiting at a stoplight after call. Working in teaching hospitals in the city is not without risk.

I hit the West Coast where I went to New Mexico, San Diego, San Francisco and Sacramento. I made two stops in San Francisco, neither was without hitch. I had a friend in Chicago from the Bay Area. Her father owned an abandoned Chinese grocery store in San Francisco and for some reason I took her up on an offer to stay there. I think I was delirious for not staying with my relatives both times I was in San Francisco. The Chinese store was actually a bomb shelter in disguise with the requisite dank, crumbling walls and a bath tub, not shower, with rusty water that was cold. The bed was like sleeping on a prairie dog village and it got broken into the night of my presence so I had to listen to people downstairs while trying to sleep. There was no phone.

I took off to Sacramento and upon returning, for my interview at UCSF, the next day, I stayed at a Holiday Inn on Lombard St. where I thought I would be safe. The next morning when I got to my car it too had been broken into. San Francisco seemed to have a problem with breaking intos. They took the radio and left the dashboard on the front seat. After reporting to the police I drove to the interview at San Francisco General hospital with the dashboard in my lap. I was late. I also noticed that during a research conference in a very crowded room, after some meetings with staff, that my fly had been open, yawning to the world. This was a trip that I have written off to bad chemistry and payment for previous indiscretions in my life. I didn't end up in San Francisco, but did get to New York at NYU. Nothing but bad hair during that interview, and I liked the city.

Finally, following another fellowship after NYU, at Stanford where I did not stay in San Francisco, I interviewed for work in the Pacific Northwest. There was little to be had at the time since the Clinton Health Care plan scared pulmonary groups into limited hiring. But there was a job in Bellingham, WA. As fate would have it one of the physician leaders there had me sit in an old church pew waiting for him while I stared at a life size framed photograph of himself and his ten year old son in the same suit with matching red bow ties, arm in arm. The Hale Bopp comet led the way to this interview, the only available job in the Pacific Northwest for me. Everything was buttoned and zipped and I got the job in 1997 at the age of 37. I was ready for practice. After a few years I got work closer to Seattle where I have been until recently.

I am now interviewing again after a delightful sabbatical at National Jewish and University of Pennsylvania. I can't seem to get enough of the interview trail, or put another way, I want to find a job that will leave me off the trail forever. My conflict is that I want stability but I love a story. Ugh.

Unemployed doctor?

It's cloudy with intermittent showers in Seattle. I have essentially finished my travel for the sabbatical and am now struggling to write stiff medical writing which causes me no end of frustration. This has never been my career calling but I consider it necessary to be a rounded clinician. It is PAINFUL!!!

I will make intermittent trips to National Jewish although my money is running out so I can't go for long periods. It has been job hunting time for me over the past couple months and that has been harder on me emotionally than I was expecting. I left my partnership on the Eastside last Fall after announcing my departure a year and a half prior to that. When I announced my departure I was being stalked and receiving murder threats, I was working 80 hours a week, had few friends, and I was having visceral disagreements with a few of my partners. It was clear that I needed to change my life drastically or I was going to lose my composure in a big way. I thought that I was part of a haunted practice and hospital, but I know I was a contributor to the problem as well. I sometimes couldn't keep my mouth shut when I should have and I could not seem to gain alliances. So what does that mean? I was odd man out, wrong in the context that I worked. And as much as I enjoyed many of my patients and other doctors at the hospital, as well as the nature of my work, I was driving some of my partners, and administrators, nuts: as much as they were driving me nuts. I was a Democrat in a Republican society, a city guy in the suburbs, a square peg in a round hole, etc. As much as I disagreed philosophically with them, they disagreed with me. I couldn't contain my opinions to my eventual detriment since I now have no job, by my own doing. As much as I maintained my ideals I also cut myself off from what I enjoy immensely, medicine and the milieu of the hospital/clinic social community. I would like to think that I have learned something from this and I plan to be more politique and reticent in the future.

Ideals are important but happiness seems to lie somewhere between inward looking idealism and being an emotional whore. I haven't found that middle ground and hope that I do someday, otherwise I'm going to be a cranky old man who yells at kids and smells like moldy leaves. Ernest Hemingway had rooted ideals and boasted of judging the worth of his life by the number of enemies he had; but eventually he shot himself. That's no way to live. Maybe attending to ones deeply held beliefs is important, but not being stiffly judgemental seems similarly important. It can be isolating and off putting, and different than mere disagreement. The path between disagreeing and judging seems fuzzy. But also, when is enough disagreement enough? Enough to suggest that you're in the wrong crowd? I have learned that ethicists often pose more questions than they answer so I'll pose this answer to the above question. It's in the hands of the Lord! OK, that one isn't so satisfying. How's this? When the burden of maintaining a relationship becomes more than the benefit, it's time to move on, hoping to find something more congruent and comfortable. I hope to find it but it's not comfortable looking. It's lonely and uncertain. But indeed I brought it on myself and must deal...

I have wanted to write about some interview experiences, so I'll do it in the next blog. -Jim O'B