going awol: my exceptionally difficult decision

when i last posted, i'd just experienced a day from hell in which my body revolted and the medical system pretty much tortured me. the time since then has been turbulent, to say the least. and what i'm about to describe may well surprise you.

first, my ct scan came back relatively normal. normal enough, that is, to rule out any kind of pathological process for my pain. the antispasmodics worked nicely to reduce spasms, but my gut remained tender and sore for several days. on the up side, my mom returned to town and proceeded to feed me--so i'm finally off my diet of applesauce, rice, toast and bananas. believe me, this is a good thing.

the whole experience of the pain, the er, etc, however, left me feeling quite anxious. most of you already know that i have a tendency to be an anxious person (again, i was the cautious one of the kids; my brother was the one always running toward fire instead of away from it, like me). but i have good reason for my anxieties regarding my healthcare. to bring the point home without offering too much information, i'll turn 30 this summer, and in this decade of my 20s, i'll have lost 3 different internal body parts, been put through chemical menopause, have endured four surgeries (three abdominal, one routine loss of wisdom teeth), spent more money than i've earned trying to pay for all the procedures and doctors' visits, and, at one point, counted up that I'd been put through more than 24 pelvic &/or rectal exams in a period of 18 months. No, i'm not making this up. and i don't have munchausen's, either. i've merely had a string of really, really, really bad luck. speaking of which, does anyone know where i can get a body transplant? or a refund? or at least some *good* luck? i feel like i could be despair.com's poster child.

so...anyway...let's just say that the recent medical events have pushed some major buttons in me and that now i'm at the point of feeling rather depressed by all of it. it didn't help that i was under tremendous stress in school. in fact, tremendous may be putting it lightly. since i failed a course in the fall (i'm blushing; this still embarrasses the heck out of me), mwms put me on "probation." i'm not the only one out of 163 that's now on the dean's hit list; in fact, 3 didn't even get a chance to return for this semester--but it still really stings to be in this position. not to mention that it makes me doubt myself even more. it's a tough spot to be in, considering that this is precisely the point when i need confidence the most. but the worst thing was the pressure of knowing that if i failed another class, i'd lose my seat in medical school. for good. and i've worked way too long and way too hard to get here to let that happen.

the_godfather has been working hard to coach me through this process and I really don't think i'd have gotten this far without him. in fact, i'm convinced i wouldn't have. but what he showed me last week was probably the most powerful thing of all. i've been doubting myself so much that i keep getting paralyzed. i freeze on tests and i've generally been feeling, well, stupid. in pbl last week, however, something major shifted.

throughout the week, i ended up in positions where i was leading the group. this was particularly profound last friday, when i was given the role of scribe (the person who writes case information on the board and directs the flow of the group discussion). that day, i realized that my intensive liberal arts training, in spite lacking science training, prepared me for clinical cases in an amazing way. i know how to ask questions. i know how to lead group discussion. i know how to teach. and, somehow, through all of this, i've developed instinct--this sense that i know how to approach a case in a logical, yet thorough, manner. and i remember the human side of it all, too, which is not always an easy feat when your patient is on paper and your whole group is intent on "solving the case" rather than thinking of it as a real live situation that we'll face someday soon. i was stunned by what i was able to do in pbl on friday. during wrap-up, all my group-mates commented on it. since beginning of medical school last august, it was the first time i've felt confident in my abilities. and let me tell you: it felt really, really good.

friday afternoon, after a long discussion with some of my classmates, i went for my weekly meeting with the_godfather. before i reached his office, though, i ran into biochem_enthusiast, my facilitator from the first 10 weeks of these past two semesters. he is also an exceptional teacher and a very interesting person, even if he does sometimes get hyper-obsessed with those pesky little molecules that do everything in our bodies. ;-) he was concerned about me and, for the second time, questioned as to whether i should take a leave of absence. hmm...

i went to see the_godfather next. 28 days out from a big pbl exam that would basically cover all of neuroanatomy (on which we have not been lectured; we've merely read the book and taught ourselves), i was starting to hit the peak of my panic. and that's when everything began to unravel. the_godfather pointed out that i was performing well in pbl--so well, in fact, that i'm often two steps ahead of my colleagues. he also noted that this is not showing in my exams because i'm freezing. i mentioned that i'd tried taking some anti-anxiety medication, but that it had been sedating (and therefore not very helpful for exam-taking purposes), but he stopped me. "this is not a physiological problem," he said. "this is a mental problem." and, in hearing him say that, i knew he was absolutely right. he was also quite accurate in pointing out that i've had a rough year. i threw out my back right at the beginning of the year, which subsequently threw off my studies at a crucial time, and then, right about the moment i was recovering from that, my grandmother died, as did one of my favorite high school teachers with whom i was close. combine that with undiagnosed gallstones and the pain they cause and, well, you get where i'm going: first semester was a nightmare. [a note on this: i wrote a lot during that time, but i haven't published it here yet. i haven't decided whether i'll go back and add these to the blog or not, but i thought i should explain why some of this is just being mentioned for the first time.]

when you add into the mix that this semester has involved illness, surgery, recovery, and more illness, it's clear that i haven't had the opportunity to adequately learn the material, let alone show that i've learned it. so, to make a long story shorter, i finally made the decision to take a leave of absence from medical school.

*gulp*

after working so hard for so many years to get here, it's hard to believe that i've made the decision to step away from medical school. in fact, it feels completely surreal. but here i am, one day after the official clearance from dean_honey (who, upon hearing my decision, said "honey, you're making the right decision. you should've done this months ago. i'm glad you've gotten over your stubbornness."), and i feel like i've been shot out of a cannon or something. it's...overwhelming.

so what does this all mean? well, other than another $50K in student loans (i must be crazy to be doing this), it means that i get to repeat the first year of medical school. so now i'll be in the class of 2011 instead of 2010. this feels *very* strange to me.

on the upside, though, i now have four months to get my health under control (<--maybe that's not the best phrase to use...maybe i should say more balanced...because i clearly have no control over this crap whatsoever). i also will have a chance to fill in some of the gaps in my education (since i wasn't a science major in college, i still have some areas of science that are unfamiliar to me, in spite of all those post bacc classes i took). if i can find someone willing to hire an overqualified slave (will work for food!), i may be able to earn a little money, too. that would certainly feel good.

in the meantime, though, i'm reminded of one of my favorite episodes of the west wing. (yes, i'm a wingnut. i loved that show. i'm not usually addicted to tv, but i never missed that one.) in it, cj is exercising on a treadmill and her pager goes off. so she's trying to check her pager and talk to the guy next to her. that's when she trips--splat--and gets thrown off the treadmill. that's *exactly* what this feels like.

*splat*

the human pincushion

today began as a good day. thanks to the recent med changes made by mr_dr_do, i'd had a relatively productive weekend (one where i at least slept at night and was awake during the day--amazing how much that helps!) and i got to pbl bright and early, ready to dig in to another case. we'd just switched facilitators the week before (for our pbl groups, there are 8 students and 1 facilitator. the groups shift every semester, while we switch facilitators every 10 weeks or so) and i'd had the miraculously good fortune of getting my advisor, the_godfather, as a facilitator for this section of the term. i cannot even begin to tell you how excited i was by this. the_godfather is an amazing teacher, not to mention one of those rare people who can be honest and diplomatic at the same time. i knew he would mold our group dynamics to the point that we'd become a productive, respectful, and self-sufficient learning group.

when the_godfather walked into the room that morning, he asked me how i was feeling. it was the first time since the surgery that i reflexively and unhesitatingly said, "good!" and really meant it. we began our case, which involved some difficult interpretations of a CT scan, where we were trying to find one of the strangest-sounding tumors you can imagine (a pheochromocytoma). i had the opportunity, in the midst of this, to ask some particularly crucial questions. my colleagues tried to ignore me, but i became more persistent than usual. heck, i was feeling well--and i was very excited about how this case was teaching us to combine neuroanatomy and endocrinology. so, i particularly kept pushing for the group to identify a big glowing spot on the CT scan (in a CT, the stuff that shows up bright white is either really dense, like bone, or something that has picked up a lot of contrast material, if contrast was used, such as blood vessels). after a few minutes of tangents, the_godfather finally said to the group, "and what is that big glowing spot there?" sure enough, it turned out to be the tumor.

By the time we finished reading the scan, we'd been in group for almost an hour. then, all of a sudden, out of nowhere, my gut spazzed out. it was one of those experiences of pain where at first you think, 'oh, that really hurts...but it'll pass...it's probably gas or something.' but it didn't get better. in fact, it got worse. a *lot* worse. i lost track of where the group conversation had gone. i was trying to breathe and desperately hoping i wouldn't throw up on the table. within what must have only been a few moments, though, i broke out into a cold sweat. that's when i started to realize i was in trouble. after about ten minutes of sitting there like this, i finally whispered to the_godfather that i needed to leave. now.

i packed my books and practically ran from the room. i got to my car, hoping, again, that being out in the fresh air might make me feel better, but my pain was increasing. i didn't even think about it--i knew i needed to go to the er. stat. given that my mom, who'd stayed with me for a while after the surgery, had gone back home for a bit, i knew i had a small window in which to get myself to the hospital. fortunately, this new planned urban development (pud) i live in has a hospital in the middle of it, so i only had to drive a few miles.

i got to the er and it was busy considering the size of the small place. it took about 45 minutes before i was brought into an exam room, and, at that point, my pain had already begun to dissipate. i was relieved that it hadn't gotten worse, but also a tad undone by the fact that it had had a sudden onset and such deep intensity. the attending physician finally came in, poked my belly, and said he'd run some tests. he then asked me if i wanted anything for the pain. i didn't, at that point, feel that i needed a painkiller so much as an anti-spasmodic--a medication that would relax my muscles and stop them from remaining in this horrible contracted state. he agreed, and then went on his way. a little bit later, one of the nurses comes in with an injection. i raised my eyebrow at this--the antispasmodic i'd requested comes in a fast-acting sublingual form, as well as tablets, so i was surprised by the choice of an injection. now, my medical history is lengthy and complicated enough that i've long gotten over my fear of needles. i've even had to give myself intramuscular injections before. but i must say that any medication that does not last as long as the injection site remains sore is a medication that really needs to be rethunk. my butt hurt like mad for the rest of the day.

i slowly started to feel better, but still was unwilling to uncurl myself from around the quasi-pillow they'd provided me. a guy, resembling the age of a sixteen year-old, came in and placed my iv. i was surprised--and relieved--that he got it on the first try, as i have notoriously difficult veins. he drew several vials of my blood and then capped off the port in case i needed iv access later. then i waited. and shivered. and waited some more. an er is, truly, a terribly uncomfortable place to be when you're ill. i didn't want to complain--where i come from, er waits are usually about 12 hours long, and that's just to get through triage. so being in this small hospital, i actually felt relieved. it was a busy morning, but i knew that busy is relative. besides, i've worked long enough in healthcare to know when to be patient. the billing rep who came into the room to get my insurance information nearly passed out when i automatically handed her my insurance card, driver's license, and credit card for the copayment before she had a chance to ask. she spent the rest of the morning periodically walking past my room, popping her head in, and threatening to make me work if i didn't get out of there soon.

i think it was about 1:30pm when the doctor finally reappeared (the whole incident had started at just after 9am). he said that all my tests were negative and that i probably was just experiencing irritable bowel syndrome (ibs) from the surgery. that surprised me--ever since my appendix ruptured eight years ago (and wasn't diagnosed for over two months...), every doctor i've seen has given me this wastebasket diagnosis. [a note here: a wastebasket diagnosis is one that is given when there are clearly a constellation of symptoms that people have that can be grouped together, but where the cause is unknown. it's sort of like saying, we don't know what's wrong with you, but here's a label for it. it doesn't describe anything about how or why the problems occur, how it might progress, or even what might treat it best. hence the term, wastebasket diagnosis.] i get it--my bowel is pissed off. but any one's bowel would be pissed off after 2.5 months of purulent infection, followed by two surgeries and a host of other complicating factors. never, though, had my "ibs" ever caused pain that severe. never. nor had i ever read about someone experiencing this type of pain with ibs as the underlying cause. so i was, needless to say, skeptical. he then said he'd give me a prescription of the antispasmodic i'd been shot with; when i asked if it would impair my cognitive function (an important thing to know when one is a first year medical student), he said, "well, do you feel extremely sleepy now?" i didn't feel extremely sleepy right then--but i knew i was still on an adrenaline rush from the pain and my subsequent fear. so, thinking he'd proven his point, he attempted to leave, but before he could i asked about what i should do if the pain comes back this intensely again. he just shrugged, said to take the medication, and basically blew me off.

by the time the nurse came in with my discharge papers, i was angry. it didn't help that the first thing the nurse asked was whether or not i'd driven myself to the hospital. my response: why, yes, i had. to which the nurse replied, "oh. i don't know if you should drive after taking this medication, it can make you drowsy." i pointed out that the doctor had just told me that this wouldn't impair my function, but the nurse read down the sheet, found the section on side-effects, and sure enough, first thing: "may cause drowsiness or dizziness; avoid driving or operating heavy machinery until you know how this medication will affect you." it was a good thing the doctor was gone by this point, because i might have hit him if he'd still been around.

after finally getting the catheter removed from my arm and climbing back into my warm clothes, i left. i stepped out into the sunlight and walked to my car. i got into the car, and that's when i lost it. i just started crying...i couldn't believe i'd just been treated like an idiot by (yet another) physician...i couldn't believe i'd just paid out the nose for this privilege (er visits have a hefty copayment with my insurance)...and i couldn't believe that after all of this, i had no more idea as to what had just happened to me than i did when it started.

i decided to call the dr_do's and see if they could see me. fortunately their office is awesome (i swear, i have never seen a primary care physicians'/family practice office run so smoothly or be so accessible), and mrs_dr_do agreed to see me. within an hour, i was in her office, explaining what had happened. i'd had her as a professor for one of my classes in the fall, but had never seen her as a patient. i was a bit nervous about this at first (i'm really damn picky about who i allow to treat me after what i've been through over the years), but she immediately put me at ease. she was incredibly helpful, gave me advice, and then ordered a CT scan for me. since i could either go for the CT right then, or wait ten days for the first available spot, i decided to take the appointment that evening. i drove from their office to the CT place, which, fortunately, is only about a block from where i live.

i like this radiology center--i'd been there for my second abdominal ultrasound a few months prior, when my gallstones were finally discovered. the staff there is incredibly nice, and they do some neat things to ensure patient comfort--like providing us with scrubs to wear for the test instead of making us wear those ridiculous paper-thin hospital gowns. i felt relieved to be there and eager to get to the bottom of my problems.

unfortunately, however, i hadn't had anything to drink since before 8am except for the awful, horrible, barium contrast material. so i knew i was dehydrated, which is not a good position for me to be in when someone wants to place an iv in one of my veins. i inherited tiny, deep, rolly veins--in short, i'm a difficult stick. some phlebotomists continue to run in the opposite direction when they see me coming, that's how bad it is. but i'd been having good luck with labs in this town so far, so i wasn't overly worried. at least, not after the first attempt. then there was the second attempt. and a third. at this point, i was ready to let the guy do the damn scan without the intravenous contrast. but he said he'd try one more time (and not dig around this time) to see if he could get it. i guess for me, the fourth time is the charm, because he finally hit a vein in my hand and got the catheter to stay in place. by this time, though, i felt absolutely ill. the insides of both my elbows were raw, as were the backs of my hands. it sucked, to say the least.

antecubital fossa
(i.e. inside elbow)

back of right hand

in an attempt to appease me, though, the technician let me look at my CT scans on the computer. it was exciting to know that i could read them; thrilling to know that i didn't have a pheochromocytoma like the morning's patient; and basically amazing to get to see my body on a screen like that. i could see where the surgical clips had been placed during my laparoscopic cholecystectomy--so that was pretty amazing, too.

by the time i left the imaging center, though, i was a complete mess. i came home, tried to write out some of my feelings on this blog, but ended up saving it for publication until later. mrs_dr_do had insisted that i take a narcotic as well as an antispasmodic for the pain (my gut had been so tender when she examined me that i kept apologizing for guarding the whole time), and, although i really dislike taking narcotics, i followed her instructions and then proceeded to sleep through monday night and almost the entire day tuesday.

i was still sore when i awoke, but the medications had clearly helped. what i couldn't shake, though, was the fact that i'd spent a day as a human pincushion...and got no answers from it. the whole experience left me feeling bewildered, frustrated, angry, and a bit horrified that i'd gone from feeling well to feeling like someone was wringing my guts from the inside, within a matter of moments.

the lingering fears remain: will i ever feel better? will i ever have a consistent period of time where my interactions with the healthcare profession as a patient are positive? what the hell just happened to me? is something wrong, or am i going crazy? will i forever be a human pincushion? i guess only time will tell....

self-doubt

like the proverbial deer in headlights, i'm paralyzed. i've spent the past hour "trying" to read a chapter from my neuroanatomy textbook, but without any success. but there's the rub: in medical school, is there such a thing as success? and if so, what does it look like? i ask because i haven't found it yet....

throughout this whole first year, my colleagues and i have been involved in a dance of sorts--one where we're constantly being evaluated (there is, i kid you not, an exam of some kind every week, if not more often) and consequently re-evaluating ourselves. it was suggested to me, when i was a pre-medical student, that it takes aggression to survive and succeed in medical school; this, of course, was always presented to me in the context of me being deemed by someone to not have enough aggression to get into medical school, let alone through it. what i'm finding, however, is that it isn't aggression that is needed to be successful here. rather, it seems one must be completely unaware of any self-doubt one might have--and that's where i get definitively stuck.

over the christmas "break," i spent some time with my younger brother--i'll call him super_blaze for reasons that will soon become evident--who has decided to train for a triathlon. he'd gotten a training book that he shared with me. in it, there was an anecdotal story that i found quite interesting. it was about bumble bees. apparently, some scientists decided to study the bumble bee to see how it flies. after all, it's shape isn't exactly aerodynamic, nor are its proportions particularly indicative of flight capacity. so, the scientists did tests, and more tests, and even more tests. do you know what they determined? their studies proved that the bumble bee can't fly. as the book aptly noted, it's a good thing nobody told the bumblebee that. :-)

i suspect this is a quality that must also be inherent in someone training for a triathlon--after all, is it not hubris to assume that one can swim, run, and bike all those miles in one stretch? apparently super_blaze doesn't think so, because he's doing it. and it's amazing. but then, he's always been the type of person who can, for instance, jump off an eighty foot water tower and enjoy it. (<--no, i'm not making that up. he did that. and he didn't end up in the er, either.)

but i'm not super_blaze. (i must have been the practice trial in the gene development department for my family, because i developed with an intense fear of adrenaline endeavors, as well as a predisposition for losing body parts in spite of being relatively kind to my body....) i'm rather conscious of the fact that i cannot fly. in fact, one might say that i'm hyper-conscious of my limitations. but i'm beginning to think that, rather than serving as some protective function, this awareness is turning out to be a barrier. one that, in particular, precludes success in medical school.

so...how do i unlearn the consciousness that trying to learn all of neuroanatomy in six weeks is absurd? how do i convince myself that i can learn this, rather than assuming from the outset that i'm doomed to fail (again)? if i've already experienced failure here, then how come i'm so afraid of having it happen again? why am i so tangled up in my feelings about all of this?

i sure wish i had some answers....

blog tweaks

i decided to add some flavor to my blog and i want to share some of the changes, since they may not be readily apparent.

the most important change is my addition of case files. for those of you who've studied medicine and/or have been a patient long enough that you know how to read your own chart, my creative license will be readily apparent to you. for those of you who haven't studied medicine, a bit of background information here: during the first semester of medical school, medical students learn how to take a patient's history. this is always recorded in a particular manner and then presented back to the more senior member of the medical team as a "SOAP" note. since i want my blog to remain semi-anonymous, i didn't want to describe people by their real names. but people are what make my life colorful, so i wanted a way to bring them into my posts. hence, i made up "case files" for some of the people i talk about. the pseudonyms in the posts will allow you to link back to the case files so that you can learn more about that person if you so desire. i see it as a way of providing more context for my ramblings. [N.B. these case files are meant to be funny. they in no way represent a popularity contest or anything of the sort, and for some, identifying information has been tweaked to protect the innocent (or not so innocent, as the case may be!)].

in addition, thanks to google, snap and librarything, i've been able to add some neat features to the sidebar (like links to medical articles i read and find interesting) and also a preview feature for the links in posts (hover your mouse cursor over "history" in the paragraph above and you'll see what i mean). i've had fun with these; if there's anything else you'd like me to add, just let me know. i'm discovering that people put all sorts of random information in their sidebars, like what they read last, the last movie they saw, or their "favorites." i tend to want to share things, like articles and books, that open up peoples' knowledge of medicine and health care.

i also added a post about problem-based learning (pbl) since so much of my education is in that format right now. it helps explain all the little things that i may forget to describe when i'm writing a post.

so...that's the 411 for now. if you have any requests, please let me know! :-)

an addiction?

can blogging become an addiction? if so, i'm in trouble. it's not even the writing itself that sucks me into the time abyss, but rather that this is yet another tekkie thing for me to learn--and yes, i'm a geek. a gadget whore. i should come with a warning label. today it would say: this is my brain without any sleep. any questions?

so it seems i'll be playing around with my blog template for days to come, especially since google is always adding such great features, and because my friends' sites inspire me to do more. the best thing about today (other than getting to be the female guinea pig for my clinical exam class...but more on that later....)? wee me. it's all j.p.'s fault. you'll see....

little known facts about women & aging

this semester, in addition to being inundated with work for PBL, OMM, & CE, we first year medical students also have the privilege of taking on 4 additional 5-week classes: ethics, geriatrics, public health, & healthcare management. for geriatrics, one of our assignments is to write a review of an article. the particular one i chose, "comprehensive evaluation of the older woman," (H Amin MD et al. Symposium on Geriatrics: "Comprehensive Evaluation of the Older Woman." Mayo Clin Proc. 2003;78:1175-1185.) offered some surprising information. Here are some of the little-known facts I learned:

• in general, the aging woman accounts for nearly 70% of the caregivers of older persons and a woman is more likely to live alone, experience more years of dependency, and, in her later years, experience more financial difficulty and/or poverty than a man
  
• dementia, defined as an acquired persistent and progressive impairment in intellectual function with compromise in multiple cognitive domains is the fourth leading cause of death in older women, with a prevalence of 25% to 47% in patients over 85
• delirium, defined as an acute, fluctuating disturbance of consciousness, associated with a change in cognition or the development of perceptual disturbances, and has two causes: an underlying medical condition or medication. the most common cause? polypharmacy (i.e. 5+ medications--including vitamins & herbal supplements--taken on a daily basis)
• the prevalence of major and subclinical depression in older women is 15% and women aged 65+ are 2x as likely to have depression as men of the same age (so much for the theory that hormones cause our mood swings, eh?)
• women are twice as likely as men to suffer urinary incontinence
• falls are the 6th leading cause of death in elderly persons and contribute to 40% of nursing home admissions; there's a 20% mortality in the first year after sustaining a hip fracture
• the lifetime mortality risk of coronary heart disease (CHD) among postmenopausal women is 31% compared with 2.8% for hip fracture, 2.8% for breast cancer, & 0.7% for endometrial cancer; of women 65+, 55% experience functional limitations, morbidity, & impairment of quality of life due to CHD (and yet we hear more about cancer than we ever do about CHD)
  
• more than 1/3rd of women (ages 20-70 years) in the united states have hypertension, 25% have hyperlipidemia, 25% are smokers, 25% are obese, & nearly 60% are sedentary (i.e. all this mortality is relatively preventable)
• nearly 70% of sudden deaths in women are from unrecognized CHD; in women, 40% of all coronary (i.e. heart) events are fatal, but women with CHD are not treated as aggressively as men (traditionally, anyway--let's hope that's changing!)
• women who smoke present with their first MI (i.e. heart attack) 19 years earlier than female nonsmokers
• the onset of type 2 diabetes can be reduced by 58% in women who exercise moderately 2.5 hours per week; improvement in cardiovascular risk has been shown even in women who walked only 1 hour per week
• the lifetime risk of developing hypertension (i.e. high blood pressure) in people who never had it before who are 55+ is 90%; in persons over 50, the risk of cerebrovascular disease DOUBLES for each 20/10-mmHg increment of blood pressure level
• more than 80% of patients with diabetes die of cardiovascular disease; the risk of CHD in women with diabetes is 3 to 7 times higher than in women without diabetes
• after age 65, the risk of developing uterine cancer increases by 2x and the risk of ovarian cancer by 3x; and yet...15% of women aged 65 to 74 and 38% of women over 75 have never had a PAP smear
• endometrial cancer is the most common invasive gynecologic malignancy (but we're not even close to having developed a reliable test for it)
• age is the most predominant risk for breast cancer; 1/3rd of breast cancer cases are in women over 70; an increased risk of breast cancer was found in people who drink alcohol (but alcohol lowered the risk of CHD...pick your poison?)
  
• decreased sexual activity is influenced by the fact that by age 80+, there are 39 men for every 100 women; the geriatric population has the second highest rate of HIV infection after teenagers (proving that viagra should be packaged with condoms)
• in women aged 65+, 31% did not graduate from high school
  

dazed & confused

i'm not sure how much i've written about my post-op experience. i seem to be in a never-ending battle vis-a-vis how much personal information to reveal here. that may sound funny after posting pictures of my healing gut, but, well, that was my gut. to me, emotions are much more personal.

four weeks out from surgery, i'm still being blasted by those pesky emotions. so much so, in fact, that i've had an incredible amount of difficulty sleeping...well, at least at normal times...i seem to only be awake in the wee hours of the night, which, contrary to what one might expect, is not a good thing. given that this was starting to make me feel crazy, i decided to go back to my primary care physician (pcp), mr_dr_do. [in an effort to maintain some degree of privacy, i've decided to follow granola_mom's lead and use euphemistic names in place of actual ones. in this instance, my pcp, who is a doctor of osteopathy, is in practice with his wife, mrs_dr_do, who is the fabulous female professor that my school managed to chase off.] mr_dr_do, upon hearing me say that i was beginning to fear that i am just going crazy, said "i hate that word." :-) he's been one of the few physicians i've ever encountered who unabashedly acknowledges the real difficulties of being ill without blaming me for my symptoms. amazing, no?

anyway, mr_dr_do decided to add to my ever-lengthening list of medications. [yes, "good people," as dean_honey likes to say, even physicians-to-be and physicians themselves have medical problems and have to take medication. contrary to past popular opinion, physicians are not infallible superheroes. <--and if you have one that thinks s/he is, run for your life in the opposite direction, stat!] the good news is that, as a result, i've finally gotten some decent sleep. the bad news? i feel dazed and confused.

for instance, at this moment, i should be studying for one of the three exams i have coming up over the next two days. [yes, you read that right: 3 exams in 2 days. and i'm literally paying for this. maybe it's time to re-think the crazy diagnosis....] however, since i keep catching myself staring off into space, lost in thought, instead of focusing on my studies, i decided that perhaps a writing session would do me some good. at least then i'm doing something instead of staring. i also decided to sit on my porch to write, since that way i'll get some sun, which may convince my body that day is day and night is night and not the other way around.

sitting on the porch is still a little strange for me, though. i live on the second floor, above one of the smaller units in my condo complex. these smaller units are invariably inhabited by retirees who spend an inordinate amount of time at home. the good news is that this means there's a built-in security system; the bad news is that someone is always watching me. so when i sit on the porch and hear little_old_man below me sneeze, am i supposed to say "bless you"? when little_old_woman starts cursing in spanish (<--thanks to my friends growing up, i pretty much only learned the bad words in spanish, in spite of being in a city that is predominantly hispanic), is it inappropriate if i begin laughing? what is the etiquette of sharing living space (even if only auditorily or visually) with other people? i wonder....

but i digress. i was talking about emotions, wasn't i? hmm....

lately my emotions have brought me nothing but confusion. as i'm learning (albeit the hard way), surgical recovery is not a linear slope back to health. rather, it's more like a roller coaster, fraught with ups, downs, upsidedowns, and inbetweens. when you add surgical recovery to the stress of being a first year medical student...it's beyond comprehension, let alone my writing abilities, to describe precisely what this feels like.

as you may have noticed from my last post, i tend to get angry more easily than usual. i also am not as good at censoring myself. the never-ending sense of frustration is what hits me hardest, though. i hate feeling scattered and unable to focus. i hate that, in spite of my place on the dean's hit list (it takes talent, does it not, to go from the dean's list in college to the dean's hit list in medical school? maybe not. both the student doctor and mr_dr_do mentioned having had difficulties with medical school. it took me until this week to earn my first A on an exam. imagine what that kind of challenge poses to 160 type-A students? okay, now you have a sense of the atmosphere at school.), i cannot force myself to sit down and study for hours on end. the "maybe-it's-time-to-take-a-leave-of-absence" rumblings have begun, mostly because, unlike most professional schools, mine takes attendance. oh, and attendance is mandatory. nevermind that we're all too anal-retentive to miss class except in dire circumstances.... do they really want me to barf on the floor in the middle of lecture?

anyway, i fear i'm starting to whine rather than write, and my typing, as soft as it is, seems to bother little_old_woman (i do recognize the phrases 'too fast' and 'girl upstairs' in addition to all the four-letter words i won't mention here--who knew that little old ladies cursed so much?!?!?), so i'm going to sign off for now. besides, i'm sure there will be more ramblings from this dazed & confused medical student soon....

time for change!

first, i decided it was time to change my blog template. the dots were starting to drive me crazy. alas, my attempts to find some really neat artistic template failed when i realized that i was spending too much time tweaking and not enough time studying. so, for now, my html alterations on font, plus a different blogger template, will have to suffice.

but, when i titled this post "time for change," i wasn't thinking primarily about the template, or the impending daylight savings time debacle (does anyone know *why* we still do this? does it stem from hubris? i need my hour, dagnabit!). no, my thoughts were of a more radical sort: thoughts that call for alteration of our conventions.

my problem, at present, has to do with the conventions of being a woman in medical school. more specifically, my problem has to do with american definitions of "modesty," particularly in clinical settings. it's been insulting enough to be a female patient, one who gets asked to don a paper gown for every examination. does anybody really think that wrapping myself in paper preserves my modesty or my dignity? the darn things are practically translucent! not to mention they slide off with the slightest movement, rendering one nearly or totally naked in spite of the paper. but i digress. this week's problem isn't about being a patient, it's about the insult of being a female medical student.

****disclaimer: if you're the sort of person who cannot cope with precise anatomical descriptions of the human body, you might want to skip this post.****

that said, medical students, as i may have mentioned previously, learn the art of physical examination by practicing on one another. we do this in a large room, with a handful of physician instructors who wander around and monitor/amend our progress. it should, for all intents and purposes, be a very professional learning environment...right? wrong. first off, let me mention that the school chased off the only female physician instructor for our clinical exam class. (don't even get me started on how i feel about that--she was, after all, our best lecturer and really the only female role model here within an age range to which we could relate--i could vent for hours about my anger over her absence.) so, now, our clinical examination class (we call it ce for short) is led entirely by a staff of male physicians, most of whom are retired from clinical practice and/or getting there. don't get me wrong--some of these guys are brilliant and it's a privilege to get to learn from people who have been in practice for a number of years (i.e. 30+). since it's one of the anatomists/deans that refers to me (and every other woman in the class) as "honey," i can even say i have comparatively good rapport with these men.

however, on tuesday, our ce lab covered the cardiac exam. the night before, we got an email from one of the primary instructors, reminding us to wear our omm (osteopathic manipulative medicine) attire. this consists of shorts or sweatpants and a t-shirt. for the women, it also means we have to wear a sports bra. (the professor's email blithely mentioned that this piece of the attire was optional for the men.) supposedly, we have to wear sports bras to "preserve modesty" when doing the exam. whatever....

the cardiac exam requires that we remove our shirts, which is no big deal since we do it every week for our omm class anyway. however, in order to properly perform a cardiac exam (at least in the thorough manner in which we're taught to do it--i've never actually seen a physician perform each and every one of the components of the entire physical exam in a real clinical setting), we have to palpate the chest for the pmi (the pmi is the point of maximum impulse; it's about a 1cm spot on the chest where you can feel the heart beat up against the sternum/breastbone). when the physician instructor demonstrated this technique to the class, he (of course) chose some young chiseled man as his specimen. in order to find the pmi, the professor noted, we should find the level of the nipple line and move slightly inferior (below) that. any of you who are female readers should already begin to see the problem here. but did the professor mention it? no.

so, he instructs us to begin practicing on each other. several of the female students and i began working on each other. we quickly noticed a big problem: breasts. first off, when breasts are bound up in a tight-fitting sports bra, they don't move a whole lot. you can't really separate them, lift them, or otherwise get them out of the way without getting bound up and/or stuck in the elastic of the fabric. so, we tried to feel for the pmi around them. no luck. we tried to find the pmi on ourselves (so as not to have to molest our lab partners); again, no luck. at the 4th and 5th intercostal spaces (the areas between the fourth and fifth ribs), there is, in many of us, simply too much tissue to get anywhere near the breastbone. we were stumped. so, we did what any normal group of students would do: we called over one of our professors to ask for help.

the professor, upon hearing our question, turned bright red. by this point in the day (we'd had 5 hours of lecture already), i was too tired to censor myself, so i said, "haven't you seen like a million breasts in clinical practice? what's the big deal?" he stammered a bit and then said that it's different when it comes to students. what's different? i thought, my breasts? but fortunately, i bit my tongue before the questions came out of my mouth. essentially, we got no answer from him as to how to perform the exam properly. we were only given the impression that, in a room full of 80 students and a dozen faculty, the men were still afraid that someone would claim inappropriate behavior if they demonstrated on us.

after class, a bunch of us gathered and began talking about the experience. now i, having been a women's college graduate, really have no problem with breasts. (they're breasts, people! i wanted to shout. parts are parts!) in fact, as a medical student, after having seen cadavers and the like, i really don't have a problem with any body parts. but i also recognize that i am not everyone. some of my closest friends here are muslim. as such, they cannot remove their t-shirts in lab because we're in a co-ed lab. i asked one of them why the school did not offer her a separate lab session; apparently, one of the other medical schools kicked a muslim student out of school because she requested this. (can they do that?!?!? isn't that against our civil rights or something?!?!?)

is it 1950 again?

needless to say, i am angry. part of me wants to go to the next lab braless, but i have a feeling that'd give half the old guys heart attacks, and then i'd actually have to *use* the new cpr skills i just learned and...well...i'm not ready for that. i did end up emailing one of the professors and asking him to address the issue at the next session, but he hasn't replied to my message. am i surprised? no.

so, what is a girl to do? you might ask. for starters, never call a female over the age of 18 a girl. or honey for that matter. as for my solution? i scraped up my pennies and joined now.

a drug to endorse?

I'm not usually the type of person to endorse medications, but this is one that just may be necessary to take in order to survive medical school. It goes well with the mandatory despair.com calendar.

Thanks, j.p., for passing along the latest pharmacological miracle pill! ;-)

the on/off switch?

One of the biggest problems I have with med school is that I've discovered that my brain did not come equipped with an on/off switch. I've been awake now for about 28 hours straight, and I still cannot get it to shut up. It's a tad annoying that way....

I suspect this is not an uncommon problem, especially for those of us in PBL programs, and particularly during the high-pressure days before one of our big exams. On Friday, we have our first PBL exam of the semester. I'd try to correlate this to exams I took as an undergrad, perhaps like those at the end of a term...but really, there's no comparison. The amount of material we're being tested on is absolutely overwhelming. (I think I've said that before, but I don't think I can say it enough, you know?) On Friday, I'll be tested on 36 learning issues and 7 cases. What does that mean? Well, each learning issue is essentially one chapter from a textbook. This block of cases focused on cardiac, vascular, & renal physiology, so we're covering three units in Guyton's Physiology, which means all of cardiac physiology, all of vascular physiology, and all of renal physiology. That would be enough, in and of itself, but, wait, there's more: we've also got chapters from embryology, anatomy, histology, pathology, biochemistry, pharmacology, & genetics. Some of the material will overlap a little--e.g. there's a chapter in phys on lipid metabolism, as well as one in biochem--but basically we've got over 500 pages we're responsible to know. The cases, although much more interesting than just the chapters themselves, integrate much of the material, but they also challenge us in unusual ways. While most medical schools focus on one set of classes at a time (e.g., in a traditional allopathic medical school, I'd be taking lecture courses in physiology, histology, anatomy, embryo, etc, and they'd each be their own distinct entity like in undergrad), almost all of our work is done through the PBL format. It's great in the sense that we're getting clinical exposure early on in the form of learning how a medical case works, what lab results look like, how to interpret x-rays and such, etc; but it's also daunting to have to learn about all the different classes of hypertensive drugs when I feel I've only barely got a grasp on how normal kidney function works, let alone pathophysiology and treatment through pharmacology. And that's just one example of how I feel like I've been thrown in the deep end here, so to speak....

No doubt my experience right now is colored by my surgical recovery and all the time and energy that has eaten up, but I do wonder--is two years enough time to learn all the basic science needed to pass the boards and set foot in a hospital and start treating people? Sometimes it seems like sheer lunacy to me, this concept that I can learn all about the body so quickly.

Of course, it could be the precise reason as to why I seem to have lost my off switch: with this much information to incorporate, even sleep--however infrequently obtained--is permeated with thoughts of drug clearance curves, risk factors for atherosclerosis, and nagging questions about just how those kidney tubules actually work.... Anyone want to trade places for a day? I need a nap!

let the healing begin...

There's a saying, popular among those in the medical profession, that says that doctors make bad patients. Over the past few weeks, I've gotten a first-hand glimpse of patient life (again) and it hasn't been pretty. I've decided that I make for a rather impatient patient....

Although I haven't hit the big 3-0 just yet (I have a few months left!), I have, in my short time on this planet, managed to lose many of my "spare parts." It all began in my early 20s with a ruptured appendix, followed by the near-loss of a fallopian tube, and then the ubiquitous removal of my wisdom teeth. But, because my body clearly wanted to end the decade in the manner in which it began, last week I lost another part--my gallbladder.

I cannot even begin to describe how mad I was about having to go under the knife again. For those of you who witnessed my appendix debacle (it took 2.5 months to diagnose my ruptured appendix; yes, I should've died, but I didn't), I know I don't need to explain any further, except to note that it happened again: medicine failed me. This may seem like a strange statement coming from a medical student, but one of the reasons I decided to attend medical school is precisely to prevent such mishaps. This time, although my health care providers all pointed in the right place (my gallbladder) based upon my symptoms, the first ultrasound I underwent missed the very obvious fact that I had gallstones. Here's where I begin to have difficulty with the current practice of medicine, particularly in the U.S.: we rely too much on tests and too often ignore our own instincts.

I'm guilty of it myself. When I underwent the first ultrasound, the technician performing the scan wouldn't talk to me. Now, I know, techs are trained not to engage with the patient about what they're seeing. But most are friendly enough to at least TALK to their patients, and many will allow the patient to watch the scan on the screen provided that the patient doesn't ask for an interpretation of what's been shown (since it's the radiologist's [<--aka physician who reads the x-rays or scans, etc.] job to do the interpreting, not the tech's). So I was a tad surprised that this particular tech was so reticent. I recall thinking, "whatever, this person is probably having a bad day." But the scan took a long time. A really long time. And ultrasounds aren't known to be the kind of tests that take more than, oh, twenty minutes or so, max. Again, though, I brushed off my feelings of doubt about the tech's competence and went on my way. Here's a little known fact about medical testing: some tests are only as good as the technician performing them. This is particularly true in cases of diagnostic medical imaging, like ultrasounds. Since the radiologist can only read the images provided to him/her by the technician, the technician's role becomes crucial to the radiologist's ability to make the proper diagnosis. In my case, the scans utterly and totally missed the fact that I had gallstones. Because of this, I entered into a veritable wild goose chase to find a "cure" for my abdominal pain. After countless blood tests, x-rays, CT scans, an upper endoscopy, several trials of medications, and a trip to the ER, I ended up having another ultrasound done in the beginning of January. In this case, the technician proved friendly. He turned the monitor so that I could watch what he was doing and within the first two minutes, before he even said a word, a nice big image of my very sick gallbladder appeared on the screen. It was obvious enough that even I, who have only seen a few ultrasounds throughout my textbooks, lectures, and random experiences thus far as a medical student, knew at once what was evident on the screen. Luckily, my suspicions were confirmed when he began pointing structures out to me (he technically wasn't supposed to talk about what was there, but since I mentioned I was a med student, he gave me a personal tour of my innards that day). So...a diagnosis of gallstones befell me. Unfortunately, gallstones are one of those nasty little problems for which the best cure remains surgical intervention. I spent a good week agonizing over what to do. Had the stones been caught the first time, I could've had surgery over the holiday break and recovered in time to be back at school without having to study while recovering. Alas, no such luck. So, I had to make a decision as to how to proceed with my health care while simultaneously managing my second semester of medical school. *Not* an easy decision to make, let me tell you.... With gallstones, it isn't so much the pain that they cause that is the biggest medical concern, although anyone who has experienced an attack of gallstones will tell you that the pain is not trivial. Rather, because of where they're located in the gallbladder, the stones can pass out of the gallbladder and into the duct that goes from the gallbladder to the intestines. Unfortunately, part of this duct is shared with the pancreas--the organ responsible for, among other things, providing us with some really important and potent digestive enzymes. If a gallstone blocks the duct, the enzymes can back up in the pancreas and cause it to start eating itself. <--this is not a good thing (read: death in about 24 hours). The pancreas is not on the list of spare parts. Since it became clear that I'd already passed a gallstone (my liver enzymes had been elevated and I'd gone to the ER in extreme pain), my case was one that my PCP aptly described as "not a matter of 'if,' but a matter of 'when'" the next stone would block the duct. So, I decided to have surgery, in the form of my third laparoscopy. All said and done, the procedure went well. I gave the surgeon a bit of a challenge with some unusual arterial structure (one artery formed in a W shape instead of the usual Y configuration), but otherwise mine was a standard operation. The after-effects have not been as easy. I had the very unpleasant experience of having my bladder seize up post-op--a not altogether uncommon response that some people have to surgery such that they cannot pee afterward and have to be catheterized. OUCH. I also have managed to develop an allergic reaction to the adhesive in the bandages; as I write this, I'm doing my best not to scratch my belly, but it isn't easy! All this aside, however, I must say that recovery from this surgery is a whole lot less painful than recovering from an appendectomy. For this, and the fact that the whole ordeal is over, I am extremely grateful. For you voyeurs who like the nitty-gritty, seldom-shared details, here's a closeup of the aftermath:

Anatomy of a Gut

Now, I have to go figure out how to learn all of cardiac and renal physiology in time to pass my PBL exam on Friday; a task which, ironically, feels a lot more scary than undergoing surgery! My revised favorite expression for the experience of medical school: this too shall pass, like a GALLSTONE! ;-)

Is a "Well-Rounded Physician" an Oxymoron?

Is a "Well-Rounded Physician" an Oxymoron?
An apt way of saying what I couldn't have said better myself....

White Coat

Today marked a new beginning as my classmates and I were officially inducted into medicine via the White Coat Ceremony. It was a beautiful, celebratory event (a rare occurrence, that, in medical school, I find...), and yet I'm left with the feeling that I've crossed some great divide and am now in no-man's-land, so to speak.

I suppose that this isn't really a definitive moment--the concept that one can go from lay person to physician so quickly is, truly, ludicrous--but rather that it catalyzed an awakening into consciousness of just how much the process of medical education is changing me.

I don't have adequate words to describe what the experience of medical school feels like. I stared across the table at my parents during dinner tonight, trying, in vain, to explain my learning process here. Likening it to literature was the best I could do. Anatomy, I explained, is like learning how to diagram a sentence--what parts of speech are found, how the words are spelled and arranged, how punctuation is used.... PBL (which comprises the study of the "basic" medical sciences, including anatomy, physiology, pathology, pharmacology, biochemistry, microbiology, etc.) is like reading an anthology of literature and being expected to know not only the sentence structure (i.e. the anatomy), but the paragraphs, the chapters, the genres, the historical context of the work, etc. I'm not sure, though, that this is a sufficient analogy--but how else am I to explain this? I can only stammer, grasp at straws, and watch the rift between myself and the rest of the world grow wider and wider....

I'm hesitant even to write here. I wrote volumes last term, but not much of it felt "publishable." Is it the context? Or have I already been inducted into secrecy? I don't know. I don't know how to describe this life...but I intend to keep making the effort....

Medical News: IQ & vegetarianism

The British Medical Journal announced today its findings re: the relationship between IQ in childhood and vegetarianism in adulthood. Check it out!

From Biddle & Little

I keep trying to get in her way, but all my mom does is study, study, study.... -Biddle

Snap, Crackle, Pop

Guess what? I just cracked my first neck! :-)

In osteopathic manipulative medicine lab this morning, we began learning a method of treatment known as high-velocity low-amplitude (HVLA) therapy. It's the type of treatment you usually think of when you think of chiropractic treatment--you know, the one where the physician twists someone's neck really quickly and it looks like they're going to take the patients head off? Yep, that's the one. It's only one out of a ton of different types of treatments we learn (most of which are more like massage therapy or physical therapy), but it is, to the non-practitioner, the most high-profile/interesting treatment we use [see link above for a description of osteopathy, if you're curious to learn more].

It was pretty funny to watch a group of medical students walk into cadaver lab for the first time back in August, but telling them they have to crack each other's necks for the first time? That's truly hilarious. Everyone was nervous. We thought for sure that one of us was going to break someone's neck. In fact, the professor had us start with the neck first, because it's the scariest part--he says that once we learn this, none of the rest of it will intimidate us. It's pretty crazy, though, to see a room full of 80 students, all cracking necks for the first time.

Good news, though--I didn't kill my lab partner. Nor did I break his neck. In fact, with a satisfying pop, I fixed his neck dysfunction! Ah, the joys of medical school. It is, without a doubt, a place where there is never a dull moment. Anybody want to volunteer to be my next guinea pig? :-)

Week 10

So, it's been two months since the first exam in Anatomy. I'm now in week 10 and it's the night before the last set of Anatomy lectures. We've now officially covered all 1100+ pages of Gray's Anatomy, plus an entire Histology book and an entire Embryology book. All in 10 weeks. Did I mention, too, that I've also learned how to crack...erm...I mean fix...a joint or two? They weren't kidding when they warned us that medical school is like trying to drink out of a fire hose when you're not thirsty. I think my hose may have had some gravel in it, too. At any rate, 6 days & counting now till the final exam. Then I'll be free of the dead &amp; on to the living. ;-)

It's 1 AM...do you know where your med student is?

Oct 10, 2006 - 4 Photos

Bring out the dead!

** Important author's note: I feel the need to add a disclaimer to this entry, to warn you, in all seriousness, that this post is not for the faint of heart. If you're troubled by the concept of death, squeamish about bodies, skip this post. Otherwise, read on. But don't say I didn't warn you! **
----
Monty Python wasn't kidding. I'm not dead yet, but I feel halfway there. I'm about to begin my third week of medical school (well, or 2nd, if you count from 0 like the professors do....) and I already feel like I've been hit by a truck. This is one wild experience (experiment?)....


Friday's exam was actually not the most difficult part of this process so far. Don't get me wrong--I don't feel like I performed too terribly well on the tests (<--being the dumb-@ss first year that I am, I managed to strain my back while trying to carry my books last weekend...as a result, I spent much of the week too gorked out on muscle relaxants to study effectively)--but it was still just a test. (<--Listen to me, "just a test." Have I been invaded by aliens? Highly likely.) What may or may not have been a test: after three full days of orientation lectures orientating us to everything, we were thrown, without warning, into a room with cadavers. Four cadavers, prosected (i.e. pre-dissected), lying on metal tables, oozing formaldehyde, missing skin.... To be perfectly blunt, it was gruesome. Don't misunderstand--I've seen dead bodies before, on more occasion than I'd care to recount. But those bodies were mortuary-embalmed, shrouded in the strangeness of theatrical makeup and staged position. They were bodies. These are cadavers.


There's something odd about walking into a room where four cadavers are strewn, almost haphazardly, onto metal dissecting tables. It's eerie (I'd say pun unintended, but perhaps I'm wrong?) to view these people in sheets of flesh. It's especially odd when you don't expect to walk in on them, lying there, naked. I swear, I almost apologized!


There is something to this, I think, however. I have this strange desire to apologize to these people as I probe their muscles and veins. I am fascinated by their bodies, honored to be able to study them, to touch them, to see up close what so few get to see. Yet I wonder--what kind of person sacrifices their body to science in this manner? Did they realize, when they signed up for this, that they would be literally dis-membered in front of us? Did they imagine themselves, devoid of skin, missing fingers, having arms dis-articulated so that we could learn the minute details of gross anatomy?


I look around me during lab session, the cadavers on the tables, the x-rays and CT scan images on the light boards, skeletons hanging from wheeled racks, and I see among these things all these young, eager students. They move around with ease, sticking their fingers into bodies, around bones, and teach each other. I feel sometimes like I am the only one momentarily frozen, momentarily un-moving, wondering: at what point do we all realize that we're merely dust? When do we come to an understanding that, in a matter of moments, we'll be cadavers, too? And what do we do with this awareness? How do we hold on to this knowledge without losing our minds?


I look down at the back of the little old woman, splayed open before me, lifeless. I can only hope that in this study, through this person's sacrifice, I'll find some semblance of an answer....

The First Exam

Today is the 8th day of medical school...and the day of the first examination. Ouch. When they told us that this experience would be like drinking out of a fire hose, they weren't kidding. I'm drowning in knowledge.


At present, I'm sitting out on the second floor hallway, outside the lecture hall, waiting for my classmates to finish taking the written portion of the examination. Next, I get to go back in there and try my hand at a "practical" examination--meaning I have to make sense out of nonsense and be able to distinguish stuff on slides. My confidence in this skill is definitely waning....


Ironically, though, I'm not as nervous as I usually am before/during exams. I'm too exhausted to get riled up and everyone around me is so hyper-concerned that it's already getting old.
--
I got called into part II of the exam before I could finish this post. More on the mayhem in a moment!

Histology

Ah, histology...it's a bear, but videos like this (however rudimentary!) definitely help facilitate the learning process.

The First Day

Despite all odds, I actually made it to and through the first day of medical school.

It almost didn't happen. Murphy chased me all the way to Bradenton, where I nearly lost my seat in the class over the fact that I had an allergic reaction to the hepatitis B vaccine and therefore can't get another to ensure immunity. Four plus visits to various specialists, several needle sticks, and a whole heap of bruises later, I finally received word last week that I'd be approved for clinical rotations as long as I get tested for hepatitis every year. [<--it's actually kind of ridiculous, as they don't test us for *all* infectious diseases, and they do test us for some for which there are no vaccinations...so to think that I could've been kept out of school by one random test...well, let's just say it's been an interesting few weeks leading up to today....] At any rate, I made it. And even Murphy couldn't keep me from getting to school on time this morning, where, if we weren't in our seats by 8:15am, we'd lose our spot in the class. No joke. Which brings me to the main point of the day: the school now owns my ass. Seriously. I mean, I've been through grad school, I know that my life has to revolve around medical school, but this medical school takes all that to a whole new level. For the next few years, my every move will be videotaped and recorded by the school. I have to swipe my badge to get in the building and swipe it to get out, even though the area surrounding the school consists of a public high school full of yuppie kids on one side and a field of cows on the other. [Those damn cows, they just steal so many textbooks!] If I'm going to be late or--god forbid--absent, I have to call the dean's secretary. Even if it's just going to be by a few minutes. Literally, one of the deans told us today that, "if you get an email from my office saying that you need to be here at 10am, you'll be in my office at 10am. Don't even bother to ask why--just be there. No matter what." Needless to say, this dean was in the military before he became a medical school dean. He's also an orthopedic surgeon. Why am I not surprised? At least two of the deans are like this. One told us, point blank, that if we had a problem with one of our classes that we'd better not even dare go over his head to the other dean. Ouch. Add that to the fact that we have a dress code and we can't eat or drink (not even WATER) anywhere in the building other than the cafeteria, and, well, I'm in the army now, aren't I? I half expected to be issued a rifle. Of course, that started early in the day, right after they made us say the pledge of allegiance and then watch a really horrible, terrible very bad video of someone singing God Bless America. <--it should've been, God Help Us, as I was (thanks to my last name) assigned to a seat in the second row. It took all my willpower not to roll on the floor laughing, especially when--and I swear I am not making this up!--in the midst of all these scenes of America, they threw in a picture of the school. As if it's on par with the National Monument or Abraham Lincoln. Key words: AS IF. Okay, so perhaps I'm already turning into a cynical medical student. More likely, however, I was trying to distract myself from the waves of anxiety that kept hitting me. The best part was when we had to fill out this form that asks you to bubble in how much $ in loans you'll amass over the next 4 years. Now, we'd seen the numbers parsed down by year, more often semester--but no one ever mentioned the total. I do the math. Then I do it again. $240,000. Should I run screaming from the building now?!?!? I certainly *felt* like I should! The biggest challenge will not be the money issues, though. Surprised? You won't be when I tell you that I will take more credit hours over the next school year than I did as an undergraduate. The next ten weeks? Those are reserved for anatomy. Ten weeks...to learn anatomy? All of it? And that includes embryology. Wow. What in the world have I gotten myself into? Oh, yeah--medical school. ;-)

Steps Two, Three, & Four: Roommates, Summer Reading, & Resignations

It occurs to me, as I begin this post, that the idea of numbering these "steps" toward medical school is acutely ludicrous. Not only are there a plethora of steps, tasks, chores--whatever you want to call them--the idea that they happen in isolation, like climbing stairs one at a time, is a false assumption. As with most life processes, everything about this change is happening all at once. Does it go without saying, then, that I'm overwhelmed?

This weekend, in addition to fighting the effects of my own physician's last-ditch effort to control my endocrine disorder (I say last-ditch because I refuse to undergo these types of physiological experiments while in school...I tried it once before...it wasn't pretty...I won't do it again...), I find myself drowning in checklists as I attempt some of the most difficult chores: finding a roommate, beginning my summer reading, and resigning from my job.

The roommate task is first on the agenda purely out of need: I need to have a roommate if I want to afford food while I'm in medical school. Simple enough, right? Oh, but no.... Placing the "ad" on the class website and in the class roommate circular was easy enough, as describing the space and its parameters proves relatively straightforward. What is not straightforward: the conflagration of emotions I feel when considering what qualities I seek in a roommate.

To date, I've been blessed. After a rough initial 10 weeks at my post-bacc program (d@mn frat boys!), I got to move into a house with one of my dearest friends. We got along splendidly (a surprise, to me, because I always carry this sense that I'm impossible to live with) and it was one of the first times where I truly enjoyed sharing my space with another person. I feel spoiled by the experience, actually, since now I will, no doubt, judge every roommate encounter against the perfection of that one.... When my roommate decided not to return for spring term, I recall panicking. I rented a room in another home, but had no choice over who the other roommates would be. Fortunately, I ended up in a house with two of the wackiest women I've ever met. We shared a huge space, so we all had ample privacy, and we all had such unique schedules (we were all in different programs) and personalities that we never felt burdened by one another. The third time I had a "roommate," the context was completely different. In this instance, I lived with my (former) boyfriend. We got along well, although I did tip-toe a lot because the place we were living was, in spite of his arguments to the contrary, *his* house, not mine. Except for my caution, I was struck at how comfortable I felt living with him and sharing space. Again, for some odd reason, I always feel like I'd make a terrible roommate....

So...in considering all of this, it occurred to me that I'm now in the position of having to choose a potential roommate. We'll be in the same academic program, so the notion of having separate schedules with which to buffer our privacy is a non-option. Then there are my expectations: how do I condition myself to consider compatibility with more importance than potential friendship? And how will I feel about sharing my first home, in which I know I will take so much pride of ownership? How does one, in any circumstance, go about choosing a stranger with whom to live? What will I do when Biddle, my cat, invariably breaks in on this poor soul while s/he is in the bathroom? I'm plagued by these questions....

And when I'm not pondering these particular questions, I'm gnawing on the first few precious pages of summer reading. I don't have all the books in yet (I was able to buy some at discount from a current student, but he hasn't had a chance to ship them yet), so I had to start with pathology. As if I know anything about pathology! It is so strange to open up a medical textbook and start reading. Why? I guess because for me, for such a long time, it's felt like unattainable knowledge--stuff to which, by intellect or status, I simply was not privy. So I find, as I begin reading, that I feel like a voyeur. Here I go again.... ;-)

To add to all the drama, I had to announce my resignation at work this week. It happened unexpectedly--I'd hoped to wait at least until I'd closed on the condo--but they requested our summer availability, so I realized that the "right" thing to do would be to go ahead and let them know that I won't be around after the first week of July or so. As it turned out, there are about 5 of us that are quitting at the same time. The bosses, consequently, are scurrying around, trying to hire more people. In the meantime, sales have (finally?) slowed to the extent that we have time, during our shifts, to be bored. Boredom is not a good state for me, especially when I'm taking medication that affects my hormones. Several times this week, I caught myself ruminating on my imminent departure, wondering how I was going to say goodbye to these people (I HATE goodbyes) and trying not to feel guilty for absconding my responsibilities there. This last point is particularly ironic--a trained monkey could probably do this job better than I can...it doesn't exactly take a whole lot of skill to work a cash register (patience, perhaps, but not skill)....so the fact that I feel guilty...well, it's amusing....

At any rate...this has been my experience over the past few days: an odd whirlwind of hormones, emotions, and tasks. Since Biddle has now planted herself between the keyboard and my computer screen, I guess it's time for me to end my midnight musings for now....

A bird's eye view of the new home...

So here we have a bird's eye view of the new home, albeit still occupied by the current owner. I can't wait to spruce it up with some fresh paint & (of course!) elfa! :-)

 

Step One: Finding a Home.

Once the reality of actually signing up to join the class of 2010 in medical school finally set in, I realized that there were going to be several steps I'd have to take in order to make it to the first day of classes. Some of the steps--like ordering books, filling out copious paperwork, & being blood-let to prove immunity to disease--have been both tedious and humorous. None, however, have proven quite as intricate and intense as finding my first home....

It's been about three years since I last lived outside of my parents' home and six since I lived in a space that was fully my own. Because of a combination of illness and logistics, most of my belongings have been packed away in boxes or crammed into my childhood bedroom during this time. Needless to say, the living situation has been far from ideal! So when I finally chose where I wanted to attend medical school, I became quite excited by the notion that I'd actually get to live on my own again. Because of budget constraints, I didn't expect to have much choice about where I'd live. But then my father, who has spent 30+ years as a commercial real estate appraiser, decided that it would be a complete waste for me to spend four years renting an apartment when buying a home would likely allow me to recoop the investment of funds once I'm finished with school. Thanks to his generous (and I do mean *generous*) support, I am now in the final stages of buying my first home. (<--it's yet another situation in which I find myself pinching myself, the whole proposition seems that surreal!)

And yet, I did all the research, travelled around for days in the hot Florida sun looking at more units than I care to remember, placed bids on condos and lost them when the sellers refused to acknowledge that we're finally back in a buyer's market, and so on. I honestly had no idea how complicated the whole process is--even getting floorplans on some of these units (most of which have been built just in the last 5 years!) proved difficult.

That said, I finally was able to negotiate a viable contract on a unit less than two miles from school. It's a condo (so, yes, I have to share walls...and I know some of you regard wall-sharing units with disdain...but when I learned that this meant the condo association is responsible from repairs to everything that is outside the sheetrock out--i.e. roof, windows, siding, plumbing, exterior a/c, etc.--it became clear to me that this sense of security at having "maintenance-free" living is a small price to pay for having to share a soundproof wall....) located in a small subdivision of a rather large new PUD. It's very quiet--most of the people living in the community are either professionals (e.g. physicians, firefighters, police, etc.) or retirees--and the unit I'm buying overlooks a nature preserve.

Oddly enough, most of the units I considered first were only about 900 sq ft. I honestly didn't think I could afford anything bigger, even though at that small size, I knew it would be difficult to have a roommate. Luckily, though, I happened to find a 1461 sq ft unit in the same complex--and I'm going to be able to buy it for less than first two units I'd bid on, which were 500 sq ft smaller (go figure!). It's still going to be a financial strain (then again, what *isn't* a financial strain when living on a med school budget geared for 10 months but that has to cover 12?!?!?) to carry all the costs (mortgage isn't so bad, but the downside to living in a condo association is that because they cover things like lawn care, maintenance, cable, water/sewer, & hurricane shutters, is that the monthly fees add up pretty fast), but in the long run, I have no doubt that I'll at least recoop--if not gain a profit--from the purchase when I re-sell in four years.

So...I'm actually buying my first home. It's stunning, truly. But enough of my babble, you must see the pictures! (Keep in mind, however, that these pictures are populated by the current owner's stuff, which is totally not my taste...) Check out the next entry for a full view. :-)

6222 Rosefinch Ct -- In Progress

Jun 18, 2006 - 5 Photos

A new chapter.

The poet Adrienne Rich once wrote "We will not live/to settle for less We have dreamed of this/all of our lives." The quotation sums up my journey unto this point--indeed, it has been the driving force on many a night when I have had thoughts of quitting this whole crazy process of following my dreams to become a physician.

It took about 19 rejections from medical schools before I finally got a "yes" in answer to my application for admission. Needless to say, the road to get to this point has been bumpy at best. But now I'm here, pinching myself, trying to grok that this is really happening--that I am, at long last, going to begin medical school in just a few short months.

I am not naive--I know that this process will only become more difficult over time--but I begin having learned an important lesson. As Helen Keller put it, "although the world is full of suffering, it is full also of the overcoming of it." It is in this spirit that I begin this new chapter in my life...one that I hope to record here as it unfolds.

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