Breathing new life into my sails

Right after the my funk/MDD episode/all-time medical school low point, I started OB/GYN. As the rotation went on, I slowly climbed out of the deep hole I had been in earlier in the fall. It was the babies, the procedures, the surgeries, the patients, the Spanish. I felt like every day I was fresher, happier, and more optimistic despite the exhaustion, frustration, and disorganization that characterized this rotation.

OB/GYN fittingly ended on an incredibly high point. This is what I posted on my personal FB wall after my last L&D shift on my last day of the rotation:

It's easy to get down and lose perspective in the day-to-day grind of exams and evaluations during medical school. But then I have a day like Saturday where I delivered a baby girl into this world and unwrapped the cord from around her neck. She breathed her first breaths in my arms and a wave of relief washed over me with each one of her cries. Not only was she seemingly healthy but I hadn't dropped the baby!

As much as third year has been a struggle, moments like these make me realize how incredibly lucky I am to be doing what I love.

Even though I most likely won't go into OB/GYN I will always look back on it fondly.

Internal medicine from a future surgeon's perspective

I've been on internal medicine this month and I've surprisingly loved it. For the first week, I even considered it as a career.* But then the future surgeon in me would rear its head.

For example, I was discussing plans for discharge with my resident. The patient had come in for stomach ulcers after taking too many NSAIDs for her bilateral knee pain (arthritis).

Me: "Last problem is pain management. I discussed avoiding NSAIDs and taking Tylenol instead."
Resident: "What would you do specifically for her knee pain?"
Me: "Bilateral knee replacement?"
R: "Not quite. Try again."
Me: "Steroid injections?"
R: "How about topical gel?"
Me: "Oh yeah, that could work, too."

Next time I should probably start smaller, at least while on this rotation.

---
* Then we spent 5 hours rounding and discussing nursing home placements on a beautiful Sunday morning and that was the end of that.

Loneliness

I briefly hinted at this in a previous post, half-assedly promising I'd write about it further. Here it is.

If I could describe one feeling I've had throughout medical school, I would choose loneliness. I have never been surrounded by so many people and felt so alone.

Every day I go to the hospital, to lecture, to the library. I come home to a roommate. I bike with a cycling group and run with the November Project. I organize events on a group text. I host people for taco night, pizza night, happy hour.

Yet, I am so incredibly lonely.

Maybe I should clarify. I have no problem finding people whose ear I can talk off* but I cannot remember the last time anyone has invited me to anything or lent a non-hurried ear when I needed someone to talk to.

In fact, I was lamenting to a friend the other day that I'm really bad at planning things to do in town. She was surprised since she sees me as the planner of our group. I responded with, "That's because no one hangs out with me if I don't invite them to do something." She thought I was kidding, but I was quite serious. Another friend said she sees me as one of the most social people in our class. She's right in that I talk to everyone. What she doesn't know is I talk to people because I want them to talk back.

What prompted this post was the news that another medical student committed suicide last week (not at my school). People posted in our Facebook class group saying we should support one another and find the time to de-stress. All I could think of was, who do I call? The people who have already blown off my attempts at talking to them? Every time I broach the subject of my mental health or mental health in general, they try to change the subject or are visibly uncomfortable. They don't want my baggage.

Maybe my expectations for friends are too high. Maybe I shouldn't expect them to want to listen to me drone on and on about how much I hate third year or how I'm stressed because I cannot figure out how to get honors on my clinical evaluations. I get it. We're all struggling to adjust and get through day by day. The last thing they want is to talk about grades** or get dumped on by my stress.

Isn't that what friends are for, though? Shouldn't we support each other through thick and thin? It's so frustrating to have so many superficial friendships when all I long for is a connection with someone in my class. But everyone is too busy or too tired or only wants to be entertained. I'm not exactly a ray of sunshine these days.

Long story short, the last year has been really hard for me. I nearly quit medical school almost exactly a year ago, lived on the edge of passing my classes, had a season of intense verbal abuse as a rugby referee (the one thing that has consistently given me joy), finally decided to have shoulder surgery, got 10 stomach ulcers while studying for step (ibuprofen pre-surgery is partially to blame), then got a step score that may keep me out of orthopaedics. Now I'm struggling to get through each day impressing a different attending and resident on a weekly basis while feeling incredibly dumb and incompetent in the meantime. It's a recipe for disaster that realistically won't let up anytime soon.

For some reason, the last couple of weeks have been especially bad. I recently finished my psychiatry block so I can see the symptoms piling up. The good news is that I sleep well, I eat too much, and I look forward to most days (the ones I don't have to work). But I'm definitely not in a good place. I know that and I'm working to fix it.

In that respect, this is not a cry for help. I have a decent support network outside of school. Not ideal, but decent. I'm seeing a therapist once I figure out next month's schedule. Also, my roommate is the exception to everything I've written here. She's patient, understanding, does the dishes when I'm too tired to put my bowls in the dishwasher, and lends a fantastic ear.

She can't be everything, unfortunately, because a good chunk of my stress is school-related and she just doesn't understand. I wish I could find the medical school version of her, and I think part of my loneliness stems from the fact that I haven't found that yet even though I've put myself out there and tried. I have some good friends and shared some good laughs, but the elusiveness of that connection makes me sad.

To end on a positive note, I have a request. Please take time to ask your friends how they're doing. How they're really doing. Carve out an evening or a weekend, invite them over for dinner, and just listen to them talk. Shrink them, as I call it these days. They'll appreciate the gesture. I know I would and I'm pretty sure I'm not alone in that.

---
*I spent 30 minutes talking to the administrative assistant for our neurology rotation, whom I haven't seen in over a month, because I ran into her in the lobby of our medical school. That's all it takes for me. I talk to everyone for a long time.

**I know grades are a taboo topic. I don't like talking about them, either. Anytime I've mentioned them has been in the context of learning from people who are doing well and figuring out their strategies because mine clearly haven't been working. I don't ask for scores, just advice. I think people are so averse to the subject that they don't see the difference.

Youthful enthusiasm

My first block of third year has been a little rough, to say the least. I've struggled with motivation, the stress of trying to impress every attending and resident I interact with, and simply dressing professionally every day.

But today was different. Today was the start of orientation for the Class of 2020.

As I took my first shelf exam, I could hear the muffled voices of the incoming class of medical students excitedly chatting down the hall. Afterward, I killed time in the student lounge before my standardized patient (SP) exam while listening to the second years catch each other up on what they'd done during their summer.

Their enthusiasm was infectious and put a new spring in my step. Even though my exam was really hard and I ran out of time writing my note for the SP, I couldn't wipe the smile off my face.

Orientation brought me back to my first day of medical school and how I started last year: Terrified of what I'd gotten myself into but also excited to finally realize this dream I'd harbored since I was in high school.

I have grown crotchety since then, especially since the start of 2016 and all the stress of Step studying and shoulder surgery*. But seeing and hearing the kids in the classes below us be so excited about medicine somehow made everything better, even if for one afternoon.

I'm so happy for them as they begin this new adventure and I hope they don't forget the excitement of their first day of medical school. It's easy to lose perspective in the day-to-day grind of exams and evaluations, but when you step back for a minute, you realize that it's pretty damn cool.

---
* I haven't mentioned this yet, but I had shoulder surgery a few months ago between Step and clinical rotations. My celebratory Costa Rican vacation turned into a post-surgical Percocet haze. Potayto potahto.

Dollar signs

The other day, we had a patient in the ICU. As our team of 10 (attending, resident, intern, sub-I, and 6 students) pulled up to the patient's room during rounds, we joined the equally large ICU team in front of the sliding glass doors.

For a few minutes, the head of our team chatted with the head of the ICU team about our patient's care. I spaced out during their conversation because all I could think about was how much money had gone into educating all the people currently participating in this patient's care.

Between the 20 people (I counted) huddled around room 1001, which included attendings, residents, and students, millions of dollars had been invested in our education through undergrad, medical school, and residency.*

All to keep one patient alive.

It was a sobering realization of the cost of healthcare in this country and the long path we had all taken to be there.

---
* Although we get paid during residency, each resident's spot is subsidized by the government. So money is still being invested in their training.

It's done

Almost exactly two months to the day of my first Step 1 nightmare, I'm done with this stupid test. I wish I had some uplifting story about my journey towards enlightenment, but currently I feel like crap.

The good news is that I'm pretty sure I passed. The not-so-good news is I'm not sure by how much. And for ortho, I need to pass by mucho.

I'm mostly beating myself up for getting the gimme questions wrong. Some were so blatantly easy yet I still managed to mess them up. And there were also three questions on one concept that I just couldn't remember the answer to even though it was super straight-forward. By the time I got the third nearly identical question in my second-to-last block, I seriously said out loud, "Are you kidding me?!" It was so frustrating knowing exactly where I could find the answer to certain questions without knowing the damn answer.*

I've been trying to put it all out of my mind since there's nothing I can do until my score comes out in July. But the way the last few days have been going, I don't know how I'll make it until then. Instead of pre-step nightmares, I'm having flashbacks of questions I missed that I should've gotten right and easy questions my mind makes up just to mess with me. It's been a rough few days to say the least.

On the other hand, I've always been a good test-taker and in the last few days of studying when I totally stopped giving any shits, my practice scores went up 10%. Who knows? Maybe I'll be very pleasantly surprised like I was with the MCAT where after nearly voiding the score, I scored well above my practice test averages.

One can only hope.

---
* I'd brought a review book with me to the testing center as a sort of security blanket if I needed it. After getting the first question on this concept, I figured there's no need to look it up because they probably won't ask the same thing twice. Then I got it a second time. And again, I didn't look it up because what are the chances it'll come up yet again. Well, it did. Clearly my strategy was flawed.

My first Step 1 nightmare

I'm in the throws of studying for Step 1, in that we're one week into our dedicated study period, and I had my first nightmare about this beast last night. This does not bode well for my mental health in the coming months.

You see, I blew off medical school for the past year and half and, as a result, there are glaring gaps in my knowledge base. Couple that with the fact that I need a good score to have any chance of matching into orthopedics (my current love), and I have a lot of stress on my hands right now.

At the end of our block curriculum, I knew that I had a lot of ground to make up, but in order to see just how much, I stupidly took a practice test last week. It was a disaster. It was so bad that I spent the rest of the afternoon scouring the internet for success stories of people who pulled up their score by upwards of 50 points. Yeah, not many of those out there. So I fell into a hopeless funk and resigned myself to sucking hard-core on the most important exam of medical school. Not surprisingly, the rest of the day was a wash.

I managed to pick myself up from that mini-depression mostly by talking to a bunch of friends who have been through this before. Some confirmed my fears that I wouldn't be able to bring up my score to where I need it to be. But others gave me hope since they were in similar situations as this and managed to pull off a miracle. I work best under fear, so I'm hoping this is the motivation I need to really buckle down and study my butt off for the next month or so.

Speaking of months, I had originally set aside 6 weeks for dedicated period, which is more than sufficient according to nearly everyone. But since half of the first week was taken up by orientation administrative things and it's now been confirmed that I know nothing, I'm most likely going to push my exam back by a week to get 6 actual weeks of studying instead of the 5-ish I currently have. I lose a week of vacation, which would've been spent in the jungles of Costa Rica with my dad, but I'm going to need those extra days even if it's only to help my psyche and not so much my score.

We have a school-administered practice exam this Friday, so I'll see how much I've improved in the two weeks since my last practice test and make a decision then. But seeing how my question bank averages are going, the answer is probably not that much.

Worst case scenario, I push back starting rotations by a month to buy myself even more time. I'm pretty sure it won't come to that, but I really like knowing worst-case scenario outcomes. It keeps the stress from overflowing into hopelessness and being too overwhelmed, which is when I truly shut down. Just enough stress, and I'm super productive. But once it boils over, I may as well call it quits.

In the meantime, I'll try to keep my exam-induced neuroses to a minimum on this blog. I hope I come out of this with some sort of success story. Fingers crossed.

---
Note: I'll post more specifics about my practice exams and other scores once I'm finally done with this thing, much like I did my MCAT. I'm not so much ashamed of my practice score, but more in denial about how poorly I did. I prefer not to see the number in print again until I've hopefully managed to overcome it.

The time I almost quit medical school

A few months ago, I was done. I'd met with our dean of student affairs. I even floated the idea by my parents in a sarcastic manner to see how they would react (not well, even in a purely hypothetical situation). I was figuring out what I would do with a future that didn't involve medicine.

Partly because I couldn't imagine such a life and partly because I got some sleep and my hormones calmed down*, I stuck it out and here I am. But for about a week there, I was very close to throwing it all away.

I think it was mostly a grass-is-greener kind of thought-process, even though I like to think I've outgrown that kind of thinking. I had had an awesome summer of fun in the sun, family, and doing what I wanted to do when I wanted to do it. About a month into school, my brother threw a fantastic wedding, and then he did it again in the motherland for the rest of our family. My school and exam schedule allowed me to celebrate both of those awesome occasions, which made coming back to school in between all those festivities that much more painful.

The transition from such a high and doing all the things that truly make me happy (family, adventure, travel) to the low of things I really, really dislike (rote memorization of bullshit drugs whose names make no sense and will likely change by the time I hit the wards) was too much of a shock to my psyche. Add lack of sleep and some wacky hormones, and I was in for a perfect storm of self-pity.

There were also more legitimate reasons for why I thought medicine wasn't for me, which were much more alarming. The scariest thing was that they weren't new or original; they had just re-reared their ugly heads. I have had reservations about the medicine track ever since I seriously considered becoming a doctor freshman year of college. It's a big part of the reason why it took me nearly a decade after undergrad to bite the bullet and finally apply to medical school.**

The most disturbing was that there is nothing in medicine (including ortho) that I'm truly passionate about. This statement applies to most things in my life in that I have a wide variety of interests but nothing I truly live for. I like a little bit of everything, which is great for hobbies but not so great for the gauntlet that is medical training.

For example, over the summer, I spent a day in a rural clinic and we had a patient with really bad jaundice. Her urine was the color of maple syrup and her eyes were practically the color of my highlighter. The doctors gathered the med students around saying we'd probably never see jaundice this bad again. Everyone oohed and awwed in wonder. I couldn't care less. Funny urine. Big deal.

Maybe that simply meant that I'm not suited for primary care, which I've known for a while. Or that I was seriously burned out and needed a break from all things medicine. But in the depths of my umpteenth mid-life crisis, I kept coming back to that moment of near-revulsion and apathy which only fueled my confusion about what I was doing with my life.

What if after all this, I couldn't find something within this field that could make me happy, fulfilled, and make all this bullshit worthwhile? I wasn't looking for the highest of highs or to be the person that saves the world. I just wanted something more substantial with more concrete satisfaction than my previous job of staring at a computer screen and hoping my work would have some impact years down the line.

A year and a half into school, seemingly nothing had changed in that regard and I wasn't sure it ever would. That was the kicker. I could get through medical school and residency. Both are temporary. But if I couldn't find satisfaction in working with patients, which would be the bulk of my post-training professional life, why was I doing this at all?

For that week, I had one foot out the door. I would complain to anyone that would listen about how miserable I was and was only half-joking when I would say, "My tuition is paid through the New Year so I don't have to make a decision yet."

But, I realized I needed to stay within five minutes of meeting with my dean. Her simple suggestion to take a leave of absence to figure things out resulted in a visceral hell-no-I'm-not-doing-that reaction from me. It was pretty telling and made it clear to me that I needed to buck up, princess. Just as quickly as I had decided to quit, I was back on the med school train.

Unfortunately, threatening to quit school results in meetings with a lot of people trying to talk you out of it. So even though my dean had unknowingly succeeded in convincing me to stay during our first meeting, she also made an appointment for me to meet with Dr. D, one of our most popular and personable professors.

About a week later, I sat down with Dr. D and felt like an impostor in explaining my reasons for wanting to leave medicine, because I didn't really believe all of them anymore. But I kept up the charade to see what she would say. She essentially rehashed the same argument I gave myself when I finally decided to pursue this medicine business a few years ago.

There are so many opportunities within medicine, and patient care is only a fraction of what one can do as a doctor. If you get bored doing clinic, there's medical education, community outreach, pharmaceuticals, and Sanjay Gupta. The MD after the name opens up so many doors and puts you "on the other side of the table," as Dr. D put it. Sticking it out would have significant professional benefits and would be well worth it. She focused on my logical reservations about medicine and addressed them head-on. If I wasn't convinced to stay before speaking with Dr. D, I was definitely hooked when I was done with her.***

Months have passed since my near-quitting and although I'm now in a better place, all of my doubts about continuing with medicine have not completely disappeared. I still worry that I'm not going to fully enjoy being a physician, that I'll get bored and frustrated with my work, and that maybe something else would've been more suited towards my personality and what I want out of life.

But then I go to my preceptor and put a face to the patient whose EKG printout I just learned how to interpret. I go to grand rounds and learn the newest protocol for managing traumatic amputations. I scrub in on an ACL reconstruction and get to close a patient's wound.

When I take a step back and look at the whole picture, I realize I'm exactly where I need to be. It did take me years to finally decide on this path, but as a result, that decision was not made lightly. If I didn't give this a shot, I would regret it for the rest of my life. So even though this year has been rough, I don't regret it for a minute.

Times have been tough and will only get tougher. I'm sure this won't be the last time I'll want to quit, but I'm incredibly excited for what lies ahead.

---
*I hate blaming stuff on being a girl, but sometimes it's so obviously the case that I can't ignore it. You'd think by now I could better control my emotions but sometimes they still get the best of me. At least I've learned to recognize when that is and can just wait for it to pass to get on with my normal, adult, rational self.

**I've wanted to be a doctor since I was in high school and worked as an EMT all throughout college. I matriculated in my late 20s. To say I have commitment issues is an understatement.

***Dr. D also pegged my personality within 10 minutes of our meeting. She is an incredible people-reader and it's no wonder she's a fantastic clinician.

An update of sorts

A lot has happened since I last wrote in May (!), as it should since eight months is a long time. The bullet point version is:

• Finished first year and block of second
• Spent a month in the tropics learning Spanish and sitting under a palm tree at many beautiful beaches
• Spent another month visiting family in the States and the motherland
• Officially started second year
• Felt super lonely in school*
• Made some friends
• Went to my brother's real wedding Stateside and fake wedding in the motherland
• Nearly quit medical school (seriously)*
• Got my life together (somewhat)
• Went into the holiday break passing all of my classes (barely)

Now here I am, within eight weeks of being done with our pre-clinical curriculum. It's really scary that in four months I'll be in the hospital, seeing real patients, and somewhat having to know what is wrong with them. I know there'll be heavy supervision and not that much real responsibility. I'll adapt and do just fine, but having to integrate and apply all this knowledge that has only been tested by multiple-choice is a bit intimidating. It's all very surreal as well as super exciting!

Before all that, though, comes the monster that is Step 1. For those not in the know, Step 1 is the first of three licensing exams in the US. It's the most important test I'll take in medical school because some of the more competitive specialties have relatively high score cutoffs for their residency applicants. Orthopedics is one of those, and seeing how it's my super duper #1 choice, I have to do kind of well.

Long story short, I took the "P = MD" (P for pass) saying a bit too seriously and have barely skated by in every class since anatomy. It's not that I don't know what I'm doing wrong to get these crappy grades. I just don't want to put in the work. Give me a threshold I have to meet, and I'll be a few points above it. Nothing more. Hence the "barely passing my classes" bullet point earlier.

This has been great for my quality of life leading up to this point (I've had A LOT of free time), but it's also put me behind when it comes to being prepared for the Step. I have a fair amount of ground to make up since I didn't learn most things well the first time. But it also means I have a sufficient fire under my butt to buckle down and get things done, which is how I operate best.

---
*Posts about these topics are coming up. Stay tuned!