Eager, not anxious

Anyone have suggestions or advice for surviving the next 11 days?  I'm so ready to get this show on the road and know what the next 4 years of my life will look like!  Or, at the very least, know where in the country I will be living come June/July. 

March 21st can't come soon enough!

2013, mixed feelings

I have totally mixed feelings about this New Year.  2012 was an emotional roller-coaster.  The death of my grandmother, a rather jarring car accident, 2 trips to the Emergency room (as a patient), all the emotions of 3rd year clerkship, a hard break-up, then meeting someone new (and extraordinary), deciding to take a research year, moving to a new state, 2 cross country road trips, a trip to India... it has been a BIG and overwhelming year.

2013 was supposed to be the year I graduated medical school.  A huge part of me wishes it still would be the year I graduate medical school.  Instead, it is now becoming the year I figure out 4th year electives, begin residency applications, and try to *hopefully* get a publication out of all this research.  Ideally it will also be a year full of seeing my family, nurturing my relationship, taking better care of my health, and finding time to have fun.  Maybe I'll also make some art and learn some Spanish. 

Sundowning

According to wikipedia: "sundowning, also known as sundown syndrome, is a syndrome involving the occurrence or increase of one or more abnormal behaviors in a circadian rhythm. Sundowning typically occurs during the late afternoon, evening, and night, hence the name. It occurs in persons with certain forms of dementia and psychosis, such as seen in Alzheimer's disease. Although not widely surveyed, sundowning has been estimated to occur in 45% of persons diagnosed with Alzheimer's disease"

I feel like my current emotions reflect a sundowning effect.  I seem to get more frustrated, more teary, and more depressed as the night wears on.  My guess is it relates to the point in the evening where I used to trade in studying to video chat with the [now ex-]girlfriend.   I have cried more the last few nights then I have over the entire past year combined.  I have even succumb to sending desperation text messages to her before I could think better of it.  Thankfully my lovely roommate has agreed to take my phone away before I belligerently text her again.  My emotions are unyielding as my new reality begins to sink in.  I'm nearly as emotionally liable as my patients on the inpatient, locked, psych ward. 


The hardest paradigm shift to accept relates to my future.  I no longer have a magnetic force pulling me towards residency in a specific geographic location.  I no longer have a built in support system that will accompany me to wherever I happen to match.  It is both a relief and a curse.  It takes some pressure off of the decision to take next year off.  However, I used to be able to tell people that I was hoping for certain residency programs because it would allow my partner to have a job though I also used to worry that I'm not competitive enough for the state she is BARed in.  Now I worry that I wont match in a location with a viable singles community, a community with dating options.  How many cities are there that have large, intellectual, activist, queer, Jewish, communities?  When ever I would freak out about not matching, and ramble about some crazy scenario of scrambling into some super conservative [and boring] location, she would affirmatively respond that "we'll be okay there", "we'll make it work".   I don't know that I can do it on my own.  


At the conference last weekend, when I was asked over and over again where I was hoping to go for residency, I fought back tears while trying to explain that my perspective was recently flipped and I no longer know.  I'm pretty sure that all 1000+ conference participants were exposed to my verbal vomit about recently being dumped.  I sincerely hope that I can pull off a slightly more composed persona at the conference I'm going to this coming weekend, though I'm not holding out much hope.  When my current psych patients respond like I have been, they get dinged for over-sharing and missing social ques.   At least I still have my insight and perspective intact.  I am learning first hand that a very fine line divides the process for accepting a major life change and the diagnosis of a mental illness.

coffee

Holding a beating human heart > sleep!

Maybe I shouldn't throw pediatric cardiac surgery off the short list after all?  Something to think about when I'm not longer giddy and delirious on 3 hours of sleep.

Adding to the short list?

Yesterday morning during surgery lecture we had a specialty talk on urology.  Guess what?  I found it fascinating!  It is a procedure biased specialty.  Procedures that often allow for significant improvement in the lives of some patients.  The doctor patient relationship can develop over long term care.  It involves reproductive and sexual health.  And, on top of it all, robotic surgeries?!!!  Yep, urology is now on my short list of potential career options. 

New short list:
-ob/gyn: general, MFM, gyn onc, adolescent
-peds: general, adolescent health, PICU, neuro, GI
-urology

PICU & peds neuro

My pediatric clerkship is quickly coming to an end, leaving me wondering if this is the specialty I'm destined for.  I've loved a lot of my experience so far.  While I have liked general out-patient peds, was surprisingly impressed by some of the other sub-specialties,  the PICU and neruo have been my favorite though.  It'll be interesting to see how my future evolves as I continue on into surgery, ob/gyn, neuro & family clerkships.  (OB being the clear front-runner when I started medical school.)

A recent NYT article on Dragon Parents was appropriately timed with my experience in the neuro clinic today.  "Conversations about which seizure medication is most effective or how to feed children who have trouble swallowing..." These parents are truly exceptional and have many things to teach the world.  Their hard-earned love, compassion, and understanding of daily blessings should serve as a lesson for all of us parents & future-parents.

Confession (how I'm spending the summer)

I'm currently studying for step 1. Again. For those of who don't know, the only way one repeats a USMLE step exam again is by failing... so, yes, I failed step 1 my first time taking it in April. All be it, I failed by a very slim margin, but failed none the less. I very aggressively debated the shame vs. potential merits of writing this post, of making my failure so public, settling on the decision that this may help another med student in my position and/or someone out there might have advice for me.

I'm now officially part of the approximately 5% of US medical students who fail the stinking 300 question test of annoying detail. From what I can gather, here is the normal response to failing: 0) Consider dropping out of medical school before reconsidering when calculating the debt already stacked up. 1) Only tell those who NEED to know but hide it from the rest of the world. 2) Cycle through the Kubler-Ross Grief cycle over and over again. 3) Fixate on how this might influence your future: will I be able to match into a residency program? will I match in bumbleville, nowhere in a specialty I don't actually want to be in? what if I never pass this f*ing test? 4) Spend a lot of time, energy, and money reapplying and scheduling the exam, reorganizing your 3rd year clinical rotations, deciding on a study schedule, and motivating to do it all again.

I'm sure this comes as no surprise to anyone, but I'm not normal. I've slowly told those around me in hopes of ensuring that my support system will be well established for this go around. I've also pretty much settled into the stages of anger, more anger, and some acceptance. I'm working on the emotional aspect though, just as I'm working on relearning all the nit picky details about biochemistry and anatomy. I've come back to my parents' house to study this time so that I can limit my distractions, am using a slightly different study strategies, and am integrating context from the medicine clerkship into facts I learned over the first 2 years of med school. I'm trying but it just kind of sucks. I miss my girlfriend, and feel guilty that I'm not around to support her through BAR studying like originally planned. I miss my cat. I'm bummed that I had to pull out of my next clinical rotation. I feel guilty that I had to pull out of speaking at a conference next month in order to keep studying.... and so much more.

However, there is a silver lining to everything right?
-I traded in the awful Southern summer heat and humidity for much milder temperatures
-An opportunity to reacquaint myself with a home, and extended family, I haven't spent much time in since graduating from high school 9 years ago.
-A second pass at all of this info may/will prepare me even more for the pimping to come over the next few years
-An opportunity to increase my score from just passing to much higher (G!d willing!)
-Motivation to apply for year-long research fellowships that could help boost my CV
-After telling my medicine attending, having her strongly respond with: "you must be a really bad test taker because you clearly know your medicine!"
-A solid reminder that I'm in the minority and therefor special. We all need that every now and again, right? (Okay, so this one may be a stretch)

But overall, 3 days in to restudying, the situation just sucks. Oh well. What other option do I have than to pick myself up and keep trekking forward?

Posts will be few and far between as I fall deeper and deeper into the land of step studying but, assuming I can find my way out, I will eventually return.

Doctor x2?

I had an unexpectedly long conversation today with my old md/mph adviser. He is a man who has done amazing things in this world and who's opinion I greatly respect. He planted a seed: I should be going for a phd in health policy. He also told me that I don't need to do it now, but with the track I'm on, I should keep it in mind for the future. He basically gave me a huge complement, a very flattering charge.

Hmmm. The idea does sound appealing. Maybe one day I'll be a doctor, doctor? A MD, PhD, MPH? For now though, I really want to get out of the world and start practicing medicine. It is very much something I can think about when I have more experience under my belt.

Plan C

Since I already have my Plan B (to open a kosher gluten free bakery), today I decided on my Plan C for if this whole medical school thing doesn't pan out. I'll get a master/phd is policy and/or education and work on reforming medical education. I got in a long discussion with our Dean of Education today about the discourse between students perceived value of curriculum design and the actual value. Seeing as I'm more successful in these conversations than I currently am in step 1 studying, I'm thinking Plan C isn't such a bad one... really, I'll do anything to not study!

And for comic relief, here are "the 10 types of physician bloggers" from A Cartoon Guide to Becoming a Doctor.

daydreams about the future

For the next month of my life, I am expected to spend 12+ hours a day simply learning. When I say learning, I really mean shoving all of the "ology" (physiology, histology, pathology, pharmacology, microbiology, anatomy and clinical diagnosis) into my brain until it starts coming out my nose, and then find a way to stuff even more in there. Most of the time I think that I am totally blessed to have the luxury of spending my day with information, grappling with the complexities of the human body. I'm being trusted to learn so that (hopefully) one day I can take up the art of practicing medicine and give back to my community.

However, sometimes sitting in a study room, surrounded by books, drowning in information, getting scores of 50% or so on practice test after practice test (which I am told is normal-ish for this stage of studying) is enough to make me go crazy! During these moments daydreaming about the future keeps me motivated. My current daydreams seem to revolve around what I could do if I take a year off and where I may decide to take my future career. Topping the list:

Year off: AMSA health justice fellowship, Doris Duke clinical research fellowship, and the CDC applied epidemiology research fellowship...

Post MD/MPH degree: US public health service corps, CDC Epidemic Intelligence Service, getting a MPP...

At the end of the day, no matter how productive I was or how brain dead I am, I get to come home to my wonderful cat Lulav (can I sound any more like a lesbian?!) who simply wants me to feed and play with him. Really though, taking care of something besides myself puts a long day of studying perfectly into perspective.

My new goal:

is to either do a marathon (at least half) or triathalon by the time I graduate from med school... A bunch of my classmates ran this morning and made me realize how much I WANT TO DO IT TOO! I want to be that cool! I'm totally falling for peer pressure, as well as a desire to do something substantial while creeping through my education.

The complication is that I'm very much a swimmer and not a runner. I'm not quiet sure how to breath on land! When to start, where to start?

career counseling

In the few months leading up to Step 1 (and 3rd year clinical rotations) there are a bunch of hurdles that my medical students makes all 2nd years run through. Besides learning the computer system, getting another TB test, taking an official standardized patient exam, etc., we also have to have a career counseling session. These sessions were billed as "a half an hour opportunity to sit down with a dean". We were sent a long form to fill out and bring to the session with us.

Turns out that the half an hour session about our future was really a nine minute psych consult. A glorified opportunity to make sure that we're not about to jump off the building nor totally oblivious to our quickly approaching destiny. He asked me how I was eating and sleeping, what my study plan is, and how I am feeling about it all. He then continued by giving me advice for 3rd year. His advice? Come in prepared, be nice to everyone, show that you care, don't slack on any of the rotations including the ones you aren't interested in. Do people not know this?! It seems so logical!

In other news, I am feeling totally unmotivated by our current academic block. Turns out that living a life of endocrinology pathology translates to complete study apathy. I really need to tap into my 20+ years of endocrinology experience, and soon.

Rethinking meat

I'm seriously considering going vegetarian (again). At 13 years old I went vegetarian as a first step in wanting to be kosher. I continued to eat kosher fish, but gave up all other meats until I was 19 years old. When faced with kosher turkey at a friend's thanksgiving dinner in college, I excitedly gave up my vegetarian identity, opting instead to do my best to find "happy" kosher meat (knowing where it comes from, free-range, etc).

While in London over winter break I started to reconsider meat. After going to a few different shiurs on kashrut I started to seriously think about what being kosher means to me. I also started to grapple with the fact that it is VERY difficult to find local/ethical kosher meat, and that killing an animal in a kosher way may no longer be the quickest/most humane way to do it. Then, today, I unintentionally ended up watching Oprah's episode on going vegan. As part of the episode, Lisa Ling goes inside a slaughter house to show the process. I think that watching those few minutes of footage were enough to get me to go vegetarian again.

I'm not saying that eating meat is wrong or that we, as humans, shouldn't eat meat. Nor am I saying that you, dear reader, shouldn't eat meat. I'm just not sure that I should keep doing it. Watching the way the cows were being processed reminded me way too much of gross anatomy lab, a class that I was VERY uncomfortable with for so many reasons. I realized that given the choice, I would never choose to slaughter, skin, or butcher a mammal in order to consume it. I'm barely comfortable taking raw meat out of the package in order to simply cook it! I strongly feel that I have no right to eat something that, in its entirety, makes me this uncomfortable. Vegetables, tofu, even fish; these are all things that I will take ownership of destroying for my own nourishment.

This is not a decision I am going to make lightly (this time around). So for now all I can definitively say is that I'm in the contemplation stage of returning to vegetarianism.

choices, part 2

In an update to this post last month, I just sent in an application for the program. Still not completely sure it is what I want to do, but I am also not ready to give up on it. The sticking point is the possibility to work with state officials on improving health care. To work on health policy reform in the state capital! Or at least working within the hospital to make policy changes. That'd be SOOOOO cool and so up my alley. I figure that by applying I'm allowing someone else to decide for me &/or buying myself more time to decide on my own. Only time will tell how this all pans out!

specialty apptitude test

While procrastinating this week I took a specialty aptitude test. While I find the results to be interesting, and a good reminder that I have to excel on STEP 1* so that all options are open to me, I don't know how accurate it is. For one, I'm partially going into medicine to be trained as an abortion provider and only some of the specialties (highlighted below) will allow for that. It'll be interesting to see what clinical rotations bring and what I actually decide to go into....

Rank Specialty Score
1 thoracic surgery 42
2 occupational med 42
3 aerospace med 41
4 obstetrics/gynecology 41
5 pulmonology 41
6 nephrology 40
7 orthopaedic surgery 40
8 cardiology 40
9 physical med & rehabilitation 40
10 pathology 39
11 otolaryngology 39
12 preventive med 39
13 general surgery 39
14 rheumatology 39
15 hematology 39
16 infectious disease 38
17 urology 38
18 plastic surgery 38
19 pediatrics 37
20 nuclear med 37
21 neurology 37
22 neurosurgery 37
23 ophthalmology 37
24 med oncology 37
25 general internal med 37
26 family practice 37
27 endocrinology 37
28 radiation oncology 37
29 emergency med 36
30 radiology 36
31 psychiatry 35
32 dermatology 35
33 colon & rectal surgery 35
34 allergy & immunology 35
35 gastroenterology 35
36 anesthesiology 33

*STEP 1 is the big scary test that I have to take at the end of this year. The results will significantly impact my residency options. Reminders of how important the exam is are not necessary... it is something every medical student is well aware of.