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.

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* 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.

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*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.

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* 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.

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