Again With The Future

Okay so this year has been pretty hard.  I submit evidence for your perusal:

• my husband was deployed to fight in Afghanistan
• I got pretty classic adjustment disorder after he left and almost quit school
• Step 1 board certification exam - enough said
• my husband got some injuries overseas, but not bad enough to send him home - I had to hear about these at work via Phone Calls that started with, "Hey, we need to talk now" instead of, "Do you have a second?"
• holidays by myself for the first time ever

I haven't said much (anything?) about my husband's deployment on here for several reasons.  The first is that deployment is difficult to talk about in a way that will reach others.  Unless you have experience with being in limited contact with your loved one for months at a time while he is (as far as you know) in mortal danger, you can't really know.  I didn't know.  The second is for what the military calls OPSEC - operational security.  You never know who's reading, and so the less information that is floating about, the better.  The third is quite simply that medicine is easy to talk about.  A year of solitary nights (broken by bouts of workaholism when the silence gets too overwhelming) is not.  He has been gone from my days this last year, yet he is inescapably present - an excruciating paradox.  I hate this limbo.  Anyway.  This year is finished and I don't mind.

Next year promises to teach me about uncertainty, which makes me itch.  I've never dealt much with uncertainty.  My whole life, I knew I wanted to be a doctor.  It was a vague plan that, as I got older, developed all the necessary steps. But I've completed all of those now.  Cue nausea.  I HAVE RUN OUT OF PLAN OH NOZ. 

Just like there's the quintessential first year conversation ("I'm so stressed I will never pass this test I hate my life") and a standard second year conversation ("I'm so stressed what are you doing for boards I hate my life"), there is one conversation that all third years have, constantly, until it's settled.  It revolves around what field to go into.  And for the first time I don't mind participating in the talk because we're finally talking about something constructive.  Sort of.

My dilemma is this: I want to do missions, possibly long-term.  But what field prepares me best for that?  The easiest answer is probably family practice - primary care, teaches you to deal with all types, good for developing relationships with people.  But.  The second tier of my problem is that modern suburban family practice makes me want to go back to retail while I frequently leave the ER singing.  So do I just do what I want?  Is that a good enough reason?  Here's why that last question is even worth asking: sometimes the Lord gives us honest desires as clues to what to do next; sometimes those desires are actually temptations (not from Him) and He asks us to walk away from them.  We have to wait for His guidance to be able to reliably tell the difference.

Six months ago this was not really a problem because I didn't need to make decisions yet, but my time cushion is running out because soon I need to start arranging my fourth year.  Fourth year for osteopathic students is mostly for audition rotations - you travel to the residency programs you really want to get into and rack up some face time.  Hopefully you impress the program with how smart and personable you are and help assure yourself of a spot there the next year.  Not to belabor my point, but I cannot start setting up audition rotations if I don't even know what field to look into. 

This is by no means a unique problem - I can list five classmates off the top of my head trying to make the same decisions - but I do think I have an edge.  Just because I don't know the plan doesn't mean my God doesn't have one.  And I know He will let me know, and I know it will be in enough time for me to make the right decisions.  I just get impatient sometimes.

Okay fine, I get impatient every day.  AT LEAST I'M HONEST.

Please Don't Mind The Echo, or, How I Got Into Medical School

So let's just get it out of the way that my second medical school acceptance call, for the school I now attend, was totally normal.  I was sitting on the couch playing video games with my husband when my phone rang.  I answered, the friendly admissions lady on the other end told me I'd been accepted, I thanked her profusely, and we hung up.  It was quite nice.

This is not about that phone call.  This is about my first med school acceptance call, and it involves one of the most private of places.  Let's start at the beginning.

The application process for medical school has several steps and takes about 6 months.  After taking the MCAT (which is its own 6-month ordeal) a student has to make it through primary and secondary applications, as well as a formal interview.  Using this body of information, the school makes a decision on who gets admitted to the incoming class.  The acceptance rate is below 15% at most medical schools.

I didn't have very good grades for the first 2 years of college, courtesy of balancing real life crap and school.  This meant when I talked to my premed counselor during my junior year, he sighed deeply and informed me that I wasn't a competitive applicant.  I let that pronouncement eat at me over the next year, even after doing well on the MCAT.  I tell you all of this so you will understand just how on edge I was during this process.  By the time I'd made it to the interview stage, I was practically vibrating with nerves.

Cut to November of my senior year.  I'd just had my first! ever! interview and was in that terrifying period just after: waiting for a response.  This particular afternoon I was hard at work in my college's histology lab, memorising slides with my fellow premeds, several of whom were also anxiously awaiting answers.  And like good premed seniors, we had our cell phones with us.  Always.  ALWAYS.  I would set my phone on the edge of the tub when I showered; otherwise it stayed in my pocket or my hand, where I would glance at it constantly.  It had been a week of this, and this day was no different. 

Until I had to pee.  Perhaps you see where this is headed.

I tossed my phone to one of my friends with strict instructions to answer for me if an unknown number called and tell them I would call back.  And I was still sitting on the toilet contemplating life when the main bathroom door slammed open and I heard my friend's half hysterical voice ring out.

"Zoe!  Someone called for you!  Where are you?  I'm bringing you the phone!"

"What?  Don't answer!  I can't talk to them right n-"

"No, no, it's too late, I already picked up, she wants to talk to you-"

"But - wait - "

It was indeed too late.  A hand shoved my phone unceremoniously under the stall door and shook it excitedly.  In a panic, I Kegel'd harder than any woman ever has in history, accepted my bloody phone, and squeaked, "He- hello?"

"Is this Zoe?"

"Yes, yes it is."  No.  Oh my goodness, no.  This cannot be happening.  Squeeze, Zoe.  Squeeze!

"Hi, this is Admissions Lady from The Medical School."

"Uh, ha, hi.  What can I do for you?"  Must talk less.  What if she hears the echo?  Oh, please, Lord, please don't let her notice an echo.  Please.

"I wanted to thank you for coming out to see our school, and I also wanted to let you know that we have decided to accept you into our school's incoming class."

Pause.

"Hello?  Zoe?"

I honestly don't remember what I said after that or how I got off the phone, because all I could focus on was that if I gave full rein to my relief and gratitude... well.  I really didn't need that poor lady on the phone to hear just how relieved I was.  I do know that I laughed uncontrollably for about five minutes afterwards.  As did both my mother and mother-in-law when I told them what happened.

There are some good lessons to be learned from this.
1. We often speak of God's perfect timing.  I would like to emphasize that He also has perfect comedic timing.
2.  Sometimes we will be blessed by having humility baked into a set of circumstances.  I can never talk about how I got into medical school without that story, and it is a beautiful demonstration of how little I actually control.

November: Obstetrics

My month of OB/Gyn is almost over.  It's been pretty good if quite slow at times.  I must admit, I'm just not a fan of speculum exams.  Not because they seem too private or anything (I don't think that's a problem most medical people have, ha), but... it's just... look, if I never have to smell trichomoniasis or BV again it'll be too soon, okay?  Okay.  And hysterectomies creep me out.  I think I've finally found the area of medicine that I can't depersonalise, and it's to do with female parts.  Like how guys often wince when they watch another man get kicked between the legs.  A future gynecologist I am decidedly not.

Fetal heart sounds are incredible, though.  Run a little ultrasound machine over the mother's tummy and there they are.  They make me smile every time.  And a baby's first cry?  It gives me shivers.  I didn't think I was someone who could be overwhelmed - even momentarily - by the bright miracle of birth, but I totally am, and I'm grateful.  I can see why a lot of people like this field.  The good parts are some of the best in all medicine, in my opinion. 

At any rate, I can deliver a baby now.  Have done twice.  The pushing and crowning part (as the baby's head passes through the birth canal) grosses me out a bit, but catching the baby, all warm and squirmy and new, is really gratifying.  Partly it's because I've always felt like there's a short list of quintessential doctor things.  It's a silly, arbitrary list but that doesn't change its visceral importance to me: sew up a cut, resuscitate someone, deliver a baby, listen to heart and lungs, give bad news.  I've done all but the last now.  It's sort of staggering to realise that.  I'm still a rank beginner, but the experience really is coming.

I am really, for real, in all seriousness, no joke, going to be a doctor one day.  And not one day off in the misty future.  I am going to be a doctor in a year and a half.

^____________^

In other news, I've put my finger on what's bothering me about liking emergency medicine so much.  It was my very first rotation, and I would have been happy to do anything (I think) as long as it wasn't more class.  And it was a great time.  What I need to help get some perspective is to find some things I don't like about the field.  It's worrying to have only positive things to say; usually that's a sign that you've lost your objectivity in that situation.  If, however, I had some negatives to consider, I would feel much more secure in my preferences.

Late night moment of doubt

Spending a week around people who are more married to their jobs than their are to their spouses has left me feeling lonely and wary of my career.  Four more months of this - four years in the long term.  Working and working in order to - what?  Work?  Seriously?

It's funny.  Being out doing "real medicine" is meant to remind you of your reasoning for putting yourself through the awfulness of the first two years of medical school.  But right now it just seems like a rat race.  Remind me; why am I doing this again?

Uh, what? or, October: Psychiatry

I have a ton of work to do, so I thought I would be really diligent and blog a bit instead.  I am in psychiatry this month (yes, I know I skipped chronicling a month; a post on that is coming), and it is interesting, in that wow-crazy-people-are-crazy way.  I don't think I could do it for a living, but there's something really fun about dealing with schizophrenic people.

There was the guy who sounded totally lucid until he told us very seriously about his affair with Jackie Kennedy.

There was the lady who told us a dog was bleeding on the floor just behind us.

There was the lady who was convinced she had acid on her bra that wouldn't wash out, put there by an attacker who messes up her PJs every night while she sleeps.

There was the not-primarily-English-speaking lady who kept referring to her female case manager as a man; when the, er, discrepancy was pointed out to her, she got irritated and said, "man, woman, I don't care.  She is a female man, do you see?"  Well... no.

The rotation site I'm at is a nonprofit that offers treatment services to the poor, so of course meth and crack and such make diagnosis and treatment more difficult.  But regardless of the etiology, my attending gave me a wonderful piece of advice for talking to psychotic (= limited or no hold on reality) patients: "If you don't know what's going on, neither do they."  The lesson being, if you suddenly start wondering, "Wait, what?  Is what they're talking about even real?" then chances are the patient doesn't know either.  Don't make premature judgments, though, because truth can be stranger than fiction.  Jackie Kennedy might in fact have been a terribly loose woman when she came through the homeless areas of the Midwest.  We'll never know.

August - A Three-Part Screenplay

Scene One

Setting: Rural family practice clinic.  Zoe and her boss-of-the-month, Dr. Attending, are going over how to chart.  Or perhaps how not to chart...

Zoe: So, uh... how did you... well, know... that she had normal breath sounds when you were listening to her lungs over her sternum, over a sweater, while talking?
Attending: Well, she didn't mention a cough or any trouble breathing, so I just chart everything associated with no trouble breathing. -clickety click- I really just kinda make up stuff until I get to the coding level I need.


Scene Two

Setting: ER hallway.  Dr. Attending has just refused to give a patient any medication for his chronic pain, although that is his CC.  Patient is old and near tears, and when researched in the state's narcotics database, has no suspicious practices (e.g. getting meds from lots of different doctors, going through huge amounts of narcotics in a short time, etc).

Zoe: So, uh... refusing to give that patient any pain meds just seemed... well... how do you decide when to give patients medication and when to refuse?  Is there a hospital protocol?  What is your system?
Attending: -brief laughter- Nah, there's no protocol.  It really just depends on my mood.



Scene Three

Setting: Rural family practice clinic.  Doctor's office.  Zoe and Dr. Attending are discussing Medicaid patients and how much everyone should obviously hate how terrible they are.  Or... wait, what?

Attending: They're just very difficult.  And if you do educate them, it's like it won't even help. Not to mention the billing hassle.
Zoe: Why do you accept Medicaid?  If the patients are so difficult and the billing is so difficult, why not just do what the other doctors in the area do and refuse to take it? [Zoe gets a hopeful expression, as though she is expecting an answer indicating some sort of felt responsibility for the poor, especially in a remote area where no one else takes that patient population]
Attending: I didn't want to take them.  But after my first year, I wasn't making enough money, so I figured accepting Medicaid would increase my income a lot.  And now I need them, and even once I stop accepting new Medicaid patients, which I want to do in the next few years, I can't just fire all the Medicaid patients I already have.


THE END
~~~~

In August, I was under an attending who:

1. makes up patient visit information so she can bill for a more involved visit than she actually performed 
2. sometimes refuses to give old men pain medication because she doesn't feel like it that day, and 
3. may detest the poor, but they have their uses, so she'll keep them around for a while.

As a nice touch, she had Scripture hanging in all of her exam rooms.  -facepalm-

The Hope That Is In Me

I just found out that I passed boards.  To celebrate that, I thought I'd give an update on how my very first rotation is going.

My first rotation is an elective in the ER.  It's a fairly small hospital, and thus a small emergency department, but the medicine is still fascinating.

First of all, I will say it's astounding how little I know about day-to-day medicine.  Brand names of drugs.  Basic, common infections and diseases.  How to gracefully cut off an old lady so she will stop talking about her lunch and get back on the subject of her heart attack in progress.  All of these are things that I've been trying to pick up each shift, and they have been coming slowly but steadily.  I cannot tell you how encouraging that is.  During classes, I felt like I could never get anything right enough to be satisfactory.  I was constantly struggling against the knowledge that God was teaching me what He needed me to learn, not just about medical science, but about divorcing my sense of self-worth from my accomplishments.  I have gotten better with that, but even as I continue to walk down that journey, it is a relief to be in an environment where I'm allowed to learn things and make mistakes - where I have the room to improve.  I can put in IVs now!  And I've done a whole bunch of things that to me are crazy but to the people around me are totally normal:

• draining huge, gross abscesses.  Also draining tiny lame abscesses that were almost just pimples and the patients really just should have taken a pin and a deep breath and done it themselves.
• putting in a nasogastric tube, which is horrible for all concerned.  The tube goes in the patient's nose and down the esophagus into the stomach, which means the patient gags miserably the whole time and you feel like you're committing assault and praying you don't accidentally go down the wrong pipe and end up in the lungs instead.  And then you suction out the stomach!
• digital fecal de-impaction.  A medical term for using your medical finger to medically clean out someone's rectum chunk by medical chunk and wiping that on a medical towel.  This is maybe even less glam than it sounds.
• about 5 jillion pelvic exams.  Which, for the record, are gross.  I'm already dreading having to actually watch birth.  A future OB/GYN I am not.
• about 3 jillion digital rectal exams.  Which are not as gross as pelvics.
• suturing!  I sewed up this hand that was moderately chewed up.  I was terrified.  It was awesome.  And my suturing job was approved by the doc, so I didn't have to cut my sutures out and redo them!
• seeing things like incredible ascites, or a classic example of strep, or someone on meth asking for "ice for my pent-up rage."
• watching a dislocated finger get put back in place and almost passing out.  Everyone is a wimp about something.

So, medically this rotation has been amazing so far.  But... well, here's an excerpt from an email I sent my husband last night:

"...spiritually each day has been more of a struggle than the last.  I wrote in my journal that it’s difficult to pinpoint what’s bothering me, but I trust the sense of my soul that there isn’t a single person who works in that ER who has Christ in him/her.  Of course there are symptoms of this – endless gossip, for example.  But more than that, I’ve come to realise that I’m watching people who are cut off from the Source of all love and strength.  They are weary and, under the surface, so bitter.  And there are times during a conversation where a corner of the veneer of jokes and sarcasm peels back, tattered and thin, and there is meanness and hate under there.  And I think the Lord, in His mercy, has been allowing things to slowly ramp up to the point where it would crystallise my discomfort into outright rejection of the way these people do things. 

Two of the nurses and two physician’s assistants (PAs) made fun of a suicide note today..."

Let me stop here and say clearly that the nurses, PAs, and doctors working at this hospital do care for the patients.  They work to be nice and show compassion even when patients are being rude or demanding.  I feel certain that this is one of the "nicer" groups of staff you'll find in emergency rooms.  But because I'm on the inside, I get to hear all the backbiting, all the spite against patients, all the vitriol.  These people all work incredibly hard.  The difference between them and many of the medical Christians I have met is that the work is wearing these people out.  It's upsetting to watch.  And as for my own part:

"...my own timidity is killing me.  Each day I get a bit better at openly disagreeing with the people I’ve been working with, but I should have clearly objected to what they were saying today instead of just saying, “Are you really making fun of a suicidal patient right now?  Really?”  and suggesting – suggesting! Like there’s room for debate! – that these people really need compassion more than judgment.  And twice now I have ignored the call to pray with patients because I was afraid of messing up the flow of things in the ER.  I feel like I have been the living embodiment of Much Afraid.  And I’ve been repenting of that the last few days; still the Lord hasn’t, as far as I know, given me any more nudges to pray with patients since the last time I disobeyed Him.  I feel so bad.  These patients need true love; they don’t just need medical help, a lot of them need healing.  But I’ve been so focused on learning, on taking in, that I haven’t been giving out."

I think what I've been doing is probably pretty typical for a medical student out in the hospital: I shut up and watch.  Do what I'm told.  Work hard but generally don't interfere.  I take it all in, process it, and store the important parts for future use.  Afterwards I ask questions about parts that need clarification, and then I process a bit more.  But that only works in the areas where the person teaching me is the authority.  And because I'm currently in an environment without any other Christians, there are no spiritual authorities present besides the One who lives in me.  Which means I can't rely on someone around me to help me with spiritual direction; I have to get it all from the Lord.  I have been doing a terrible job of that recently.  And now that I've realised that, my heart feels broken.  

“No one lights a lamp and then covers it with a bowl or hides it under a bed. A lamp is placed on a stand, where its light can be seen by all who enter the house. For all that is secret will eventually be brought into the open, and everything that is concealed will be brought to light and made known to all.  So pay attention to how you hear. To those who listen to my teaching, more understanding will be given. But for those who are not listening, even what they think they understand will be taken away from them.” - Luke 8:16-18

This is a dense passage, but part of it is that the light is the light of God, and it illuminates truth and defeats lies and deception.  Christians bear that light with them wherever they go.  The second section of this passage is discussing how being willing to listen to the leading of the Holy Spirit allows Christians to increase in wisdom through their connection to the Source of all wisdom and knowledge.  People who lack this connection are cut off from the wellspring of true wisdom.

I have resolved to listen better, and obey.  I am a child of God, and I have the risen Lord directing my steps.  I need to shake off my student stupor and start living that more openly.

Uh.

It's the end of June??  When did that even happen?  I feel so confused by what my life has been for the last two months.  Let's recap.

May 1-10: finals.  My mother comes and stays with me to help out, by which I mean she does a ridiculously incredible job of helping me with every single thing around the house while I study frantically for two weeks.  The last day of finals, thanks to the poor planning of some moron buried deep within my school's bureaucratic bowels, I juggle cramming for my test and slogging my way through a 10 hour BLS/ACLS (BLS = CPR, ACLS = reviving a dead person in the hospital) online course because it has to be done by the next day and they didn't tell us until the beginning of finals.  As a result I probably don't know pharmacology or CPR, thus making me as prepared as possible for rotations.

May 11: day off.  By which I mean after going to bed at 1:30, I wake up at 6 to take my mum to the airport, cry a bunch about being alone, then go for my mandatory BLS/ACLS certification test that they have kindly scheduled on our one day of freedom.  Then I go to therapy and talk about my feelings. 

May 12 - 20: 8 hours a day of pathology lecture.  My professor, who is a brilliant educator and a total big shot, gives us a board review course that the school makes vaguely mandatory.  It is really helpful, and also excruciating.  I spend a lot of time thinking in capslock, like this: I AM SO SICK OF CLASSES.

May 21 - June 8: 12-14 hours a day of focused but sane boards studying.  By this I mean I eat regularly, exercise most days, and get a minimum of 6 hours of sleep each night.  I bought this online review course which consisted of even! more! lectures! and so I spend my time sitting at my desk facing the pool in my apartment complex, trying to learn but mostly just loathing the young untroubled idiots sunning themselves into oblivion 20 feet away.  I have a couple of moderate-strength crises ("But what if I don't do well on this test and then I am a TERRIBLE DOCTOR FOREVER?!?" -sob-).  June 8, I finish my last awful, hideously informative online lecture and feel a bit lost.  My loved ones are very gentle with me.

June 9 - 12: 16-18 hours a day of totally insane review.  I have an impossible list of things I must reread before my test, and I am meant to reread the entire 500-page review book as well.  There is no time to eat, or work out, or sleep, or study, or think.  I finally, after one last spasm of anxiety, find peace in the fact that the Lord is in control.  And praise Him for that!  I give up on the stupid review book and the bloody list and decide to focus only on my worst areas.  Late evening on the 12th I drive to my hotel in Fort Smith and medicate myself to sleep.  No, seriously.  My doctor gave me hydroxyzine (think prescription Benadryl; I've been having some allergy things) and all but told me to use it to get myself to sleep properly.

June 13: I take the COMLEX Level I.  It is a 9-hour test.  I leave feeling worn out but free and thankful.  God is so good for bringing me through that in one piece!

June 14-17: All of the furniture and random things I ordered on study breaks arrives at the same time, and I realise the apartment is a total disaster.  Boxes on top of clothes on top of dishes type of disaster.  And suddenly third year is positively looming with a whole list of demands - nitpicky things that nevertheless absolutely must be done.  Whatever.  All I can think about is...

June 18-24: vacation with Matt.  It is wonderful.  All of it.  We do too much.  We don't do enough.  We sleep too much.  We don't sleep enough.  I look at his face a thousand times and then do it again.

And now I am back in my pigsty of an apartment.  My third year starts in less than a week and I need so many things - background check, HIPAA certification, TB test, and so on.  Matt is halfway to Afghanistan and I don't know the next time we'll talk.  My kitchen is covered in dirty dishes and I have half constructed furniture sitting everywhere.  I've been trying to find my big girl panties but they're probably at the bottom of my enormous dirty laundry pile, or maybe on the floor under a stack of mail that needs sorting.



My life feels a little bit wrecked right now, to be honest.  Praying for something to give me a bit of momentum and perspective.

tellmetellmetellmetellme

Today, during lunch hour, I went to a presentation given by INF.  They are a Christian nonprofit that is based in Nepal, where they have made an astounding impact.  A bit of history is necessary here.  Foreigners, especially white people, were not allowed into Nepal until the 50s, but a brave trio - two female doctors and a nurse - lived in India on the border with Nepal for years, running a clinic and building ties with the Nepali people who crossed over to see them, and praying and praying for the border to be opened.  They were the first ones through when it finally was, and that was the beginning of INF.  And in a country where Christians are not welcome, INF has become entrenched, providing such essential medical/ surgical and community development services that the government openly allows them to stay despite their faith.

I sat there, absorbed, and feeling both thrilled and frustrated.  It sounded fantastic, but no more than that.  Something was missing, a rising in my soul.  This isn't about being picky.  This is about waiting on the Lord's guidance.  I want so much to go overseas and serve.  The little taste I've gotten of it has only increased my appetite.  So I keep going to these presentations and meetings for Ethiopia, Afghanistan, China, India, Mexico, praying and hoping for that moment when God taps me on the shoulder and says, That's it.  There.  Go there.  I know it's coming.  I just don't know when.

I know that His timing is perfect.  He won't direct Matt and me too early or too late.  In the meantime, I'm trying to stay involved in the community I think I will be part of someday, learning about social justice and crossculturalism and the true experience of ministry and on and on.  I know that the Lord is preparing my husband and me for something specific, the way He does for all His children. 

Mostly I find rest in just knowing that there is a plan and it is a good one.  But on days like today, I just want to know what it is!  Where are we going, Lord?  What will we be doing when we get there?  -stamps foot-  And are we there yet?

I tell you, if He weren't possessed of perfect patience, He would pull this car over and give me a spanking, because I would be driving Him crazy.

On Gratitude.

Today we second years had an unexpected treat.  One of our instructors brought some of his rheumatoid arthritis patients into our lab to talk to us.  It was nice because it was easy, which we all needed because we have a pretty major test tomorrow morning.  But it was also nice because it's rare to get the chance to just talk to a patient and learn about how their lives are going and how their disease really impacts that. 

One of the patients pleaded with us to have sympathy and patience with people who claim to be in pain but look fine.  Another proudly showed us how much she'd recovered while on treatment.  "I've had flares where I couldn't move, but now I'm pretty good, look," she said as she opened and closed both hands, then raised her arms out in front and then above her head. "I can straighten out my elbows all the way, and walk, and pick things up.  It's a pretty big change."

It really got me thinking about how far I've come.  You see, I've been in their shoes.  During high school/ college, I suffered from such debilitating back pain I wondered at times if I was going to end up in a wheelchair.  I know what it's like to have yet another specialist looking at you with suspicion because you look fine despite your complaints; I know how infuriating it is to see "poss. somatization" written on your chart.  But thanks be to God, I got better, and so I know how that feels too.  I was afraid to try things at first.  I was convinced I would overdo it and bring the pain and weakness back.  But now?  I can run, lift things, touch my toes, sit in chairs.  It's amazing.  But that change happened several years ago, and I haven't been celebrating it recently.

So tonight I put on shorts and loud music, and I danced.  By myself, in my little living room, despite the looming exam, I danced.  Because I can.  Because there are people who can't.  And because but for the grace of the living Christ, I would still be one of them.

So, about this third year you keep mentioning

My desktop tells me I am 27 days from the end of my second year of medical school.  I just sighed out loud.  It's an idea that I want to place on the table in front of me and just gaze at.  Wait, scratch that, it's not tactile enough.  I want to really understand that fact.  I always have this weird sense that if I could just have a physical interface with an idea, I could get into it so much better.  Eat it, rub it into my skin, smell it, mess with it like silly putty.  Something.  Then I could really, on every level, know that this is coming to an end.  It might make me appreciate the present-future a tiny bit.  As it is now, though, I can focus on the next hour, and I can focus on third year.  I have some sense that I should be looking around and trying to milk a bit of something from right now to be nostalgic about later.  It's not even the desire, though.  Just the desire for the desire to enjoy this a little.

And so I have been dreaming endlessly of third year.  What will I do?  What will I see?  What will I wear?

What?  It matters.

...Yes, it does.

Yes.

Yes, it does.  I'm not arguing anymore.  Female professionals understand this.  Hmph.

I've heard a lot of people, especially from Other Schools (oh, those distant and slightly ominous places), bitch about how miserable third year is.  But I am determined to be excited about it.  I have successfully convinced myself that third year will be a vast improvement over first and second.  Example: my feet will hurt instead of my neck!

...Well.  Let's try another one.  I will be confused about what to do instead of what to read!  No, no, that doesn't help my case either.  Er...

...I will only have to study a week or two out of every month?  Yes!  You see, a definite improvement!  And on a more serious note, I am really looking forward to putting all of this teaching into a clinical format mentally.  Don't get me wrong, they really try to give us clinical experiences in the form of timed visits and lots of mock H&Ps (history and physical).  It could never be enough, though.  They teach us how the body is put together, and they teach us how to examine it; on the other side of things, they teach us how things go wrong and what is done to (attempt to) fix those things.  But synthesizing all of that into a huge algorithm that combines reasoning and behaviour can only be done in the clinics through endless repetition.  I know so little right now.

I am thankful that I already have the interpersonal part down, and that gives me a little hope for myself.  Some of my classmates are clumsy in the exam room; they fumble with instruments and forget what they're saying; they blush during exams.  That might be the only part I don't struggle with right now.  But several of my instructors have reassured me that all of the other stuff just needs to be taught and reinforced.  I just pray I learn well.

Oh, and I guess I have Level 1 to get through, which I have to pass to start my clinical years.  But whatever.  BRING IT ON, COMLEX.  I AM NOT AFRAID OF YOU.  And by that I mean please go easy on me and let me pass through quietly to third year.  Please?

The hardest part of med school is not med school

I think the best solution is for school to exist, fairy-tale like, in a misty place outside of time (or, for those of you who prefer sci-fi, if med school were through a time warp or a stable wormhole), so we could go away for two years, get through classes, and come back to find that only a winter had passed here.  On one hand, it would be sort of extra miserable because we’d be away from our support systems.  But we also wouldn’t be around to forget to return calls, decline invitations to parties we really want to attend, neglect our spouses and children and parents, end relationships prematurely, etc.

This may seem counterintuitive, but the hardest part of med school is life outside of med school. People in med school are pretty smart overall, so classes, while stressful, are generally doable on their own.  What is not very doable is having to do midterms while your mother is very sick, or your new baby needs you, or you're massively depressed, or someone close to you is having a miscarriage, or you are having a miscarriage/ some surgery or other, or you're in a bad fight with someone you love.  Those are all things that actually happened to people I know within the last month, and in several of those cases the confluence of circumstances almost undid people.  

A note here on my own situation.  I've been doing better, and as my head has slowly cleared and I've been able to look back, I've been floored by the evidence of God's kindness to me.  Somehow He delivered me through all of my tests thus far, and considering the trouble I had getting through some of the material, that is nothing short of a miracle.  I am so grateful.  I am amazed at how He takes care of me, how He brings me through each moment.  I know that some of my classmates have gone through similar journeys.

The last eight days, or: Med School When You're Really, Really Depressed For Some Reason

So you could say I've been dealing with a major depressive episode.  I'm not sure why, to be honest.  My best guess is that my learned hatred of medical school coupled with a bunch of other personal things combined at just the right time to throw me off course almost completely.  To show you what I mean, let's use me as an informal psych case study!  Here is what the last week has been like, with a new but ultimately textbook twist at the end:

Monday I cried between every class and a little bit in class.  Then I took a test.

Tuesday I fought with everyone.  And then apologised.  And cried myself to sleep, then slept oddly.

Wednesday I think I avoided everyone because of the snow.  I thought about cleaning or making food but just sat on the couch instead, possibly doing nothing at all.

Thursday I woke up determined to have a good day.  I got my hair braided and chatted.  Then I sat in bed and cried.  A lot.

Friday I made it through a whole day of class - barely - then sat hopelessly on the classroom floor for half an hour because I couldn't pack up my things to go home.  Then I went home and crawled into bed and cried.

Saturday Matt was home.  We went shopping, and then I was so tired I slept most of the day.  And, after surfacing for dinner, a full night.

Sunday I woke up, cried, and went to church.  Then I was so tired I slept most of the day.  Matt went back to training.  I scraped myself out of bed and went to study with a friend.  Then went home and cried.

Today I woke up and it was like someone shook me awake, handed me my life, and said, "I don't know where the hell you've been for the last six weeks, but you have a test today.  And one tomorrow.  And makeup work to do.  And next week you have three tests, as well as a mock patient to see and a patient interview to do.  Get up."  And so I have spent the day in a spasm of anxiety-driven energy.  I'm grateful because it let me do things, but this is also just a different kind of wrong, albeit one I have more experience with. 

Depression is insidious and poisonous.  Anxiety is like trying to tame a beast - it has energy, it fights you.  Which means you can fight it. Fighting depression, it has seemed these last weeks, is like fighting quicksand.  The phrase doesn't even make sense to me.  You push, it gives, you get sucked in deeper.  I don't know how to deal with that. 

But at least after today I understand why they say anxiety and depression are two sides of the same coin.  At least this will make me a better doctor...?

I'm back, and boards is (not yet) looming

I've had several requests to return to this blog, so I will.  It was never just for me, after all, and the only reason I stopped updating it is because I thought interest in it had waned.  It's kind of gratifying to find out I was wrong.

I'm currently three weeks and one test into the spring semester of my second year.  A lot has happened since July whatever when I last wrote in here.  Let's see if I can summarise it reasonably well:

• I had an autumn semester, surprise!  It was rough but I guess not unduly so.  I had a lot of tests.  I learned how to give shots and that I am really terrible at doing a cohesive review of systems on a patient.  I failed utterly to learn a single fact about pharmacology despite apparently having taken a full semester of it.
• I went to a medical missions conference, and it was amazing.  This is the kind of thing that probably sounds like crazy talk to people who aren't Christian, but there's a certain kind of bright joy that comes from taking another step down the road God wants you to travel, and feeling His approval.  Spending one ridiculous, sleep deprived weekend surrounded by missionaries of all stripes - including all of the wonderful people I met at CCHS this summer! - was enormously affirming.  These are my people, even if I'm just a student still, even if I won't get to be a missionary for years and years.  These are my people.  It was awesome.
• I was basically attacked - almost repudiated - by a family member.  It was pretty heart-wrenching.  I don't think this person has ever said such terrible things to me.  The irony is that this person has no idea s/he played right into Scripture.  "Do you remember what I told you? ‘A slave is not greater than the master.’ Since they persecuted me, naturally they will persecute you. And if they had listened to me, they would listen to you."
  
• I spent a fantastic, road-trip-heavy Christmas break driving around half the country with my husband.  We had a lot of people to see, especially because Matt probably won't get to see most of those people again before he deploys.
• Speaking of, he left for training in the very beginning of January.  Thankfully, he is only four hours away, which means he has been able to come home every weekend, which I have needed because
• I am desperately burned out when it comes to being a full time student.  Not in the slightly interesting, tortured way that people get burned out on TV.  In that way where every day I struggle with a total lack of motivation and investment in what I'm doing.  For two weeks I could barely bring myself to organise my notes, let alone study them.  My house was a total mess, I lost weight... it took that long for me to figure out that it really was because I felt so miserable about returning to school.  I'm doing a bit better now, but it's still a struggle every day.  I feel like God is slowly leading me out, though.

As an interesting second year topic, let's talk about boards!!!!!!!!!!!!!  And by that, I mean let's talk about the irritating mass hysteria that boards incites.  Just so we all know what I'm talking about, medical students have to take a 3-part set of board certification exams over the course of their schooling.  The first test comes immediately after one's second year.  And it's meant to be really arse-hard, since it covers all of the material you didn't really learn during your first two years of med school.  You have to study for it.  A lot.  And the score you get determines what sort of residency program you will get into, what caliber doctor you will be, how everyone in your life will see you, whether your firstborn son gets to be named Jonathan or Maximillian-Pierre, etc.  Essentially, it determines everything of worth in your life.  EXCEPT NOT.  Yet when med students are faced with anything remotely important, they totally lose it.  People have urgent, stressed conversations in the hallways about which study program to sign up for.  Students that normally never talk to each other are expected to bond over Kaplan QBank questions.  All generally agree that "30 minutes of boards studying a night in January is totally doable," even though the test is in June.  In general, most people are terrified that there is A Key to acing boards, and that everyone has it but them, and thus everyone else has a clear, solid plan for boards and is going to do excellently while they sit alone in the dunce's corner.  That sort of thing.  It's so unnecessary.

To my poor class and all other second year classes ever:
No one has a plan for boards right now except that one gunner who wants to be an orthodermasurgicardionephrologist, and the joke's on them because they'll never have more of a life than the nonlife they have now.  Everyone is nervous about boards, but no one is working that hard for them yet because they're six bloody months away.  No one is doing 30 minutes a night.  No one is doing 10 minutes a night.  No one has read First Aid all the way through yet, and even if they had, no one would remember it.  We're taking like 482 classes this semester and we have 6 tests in the next four weeks.  I think we have more pressing concerns. 

I thought about sharing what I am doing, but I won't.  You know why?  What I'm doing should not be important to you.  Just follow the instructions we all get for hashing out a plan for boards studying: choose a target score, choose how much you are actually willing to study a week for the next month.  Stick to that.  Revise every 4-5 weeks, or sooner if your plan isn't working.  And stop obsessing over it.  And stop asking people what they're doing, because they're probably lying, and their plan has no bearing on yours.

I'm not type A enough for this crap.