A Day in the Life

People often ask me about balancing school with family. Let me begin by saying that each person's perception of balance is very personal. My equilibrium would make many of my friends and classmates uncomfortable. I'm a mom first, and a medical student second. I was a mom long before I became a medical student, and I will be a mom long after residency is over. I value my relationships with each of my children more than anything else on this earth. My ex-husband felt like I had to choose between medicine and my family. The truth is, you can have both, but it might not be how you imagined it.

In a few days, I will have my second integrated neurosciences exam. The week before the first exam, I opted to attend two professional conferences. My ex doesn't spend much time with the kids unless I'm out of town. I needed the break and they needed dad-time. The conferences were both fantastic, despite catching a bug and spending a day in bed. Need less to say, I didn't study as much as I would have liked and I definitely did not do so well on that test. Chances are, I won't do so hot on this next exam either. But that is where my equilibrium lies--I need to stay connected with my kids, and I'm simply not willing to give up any more sleep.

Since there really is no "typical" day in my life, I'll just recap my day thus far:

6:45 AM Hit snooze on the alarm.

6:55 AM Embrace the inevitable and roll out of bed.

6:58 AM Step onto the scale. How did that happen? Up three pounds this week. Yeah, yeah, yeah. Normal variations and all that, but I've "normal variated" a total of 14 pounds now since early May.

7:05 AM Enter the family room. Kids munching on cereal; books getting tossed into bags. The back-to-school frenzy of August usually takes two months to subside. I think we've finally hit our stride.

7:25 AM High-schoolers are out the door and coffee is in my cup.

7:30 AM Into the garage with youngest two, stopping at two schools before I head to clinic. I have had morning clinic once or twice a week since mid-August. It is part of my family medicine clerkship that most students do during the third year of med school.

7:55 AM Feeling awfully proud of myself for making it to clinic before 8:00 "team meeting" for the third time (which means that it has taken this long to get into the morning school routine with the kids).

8:10 AM Download Lose It! to my iPhone. The only way to fix the scale is to focus on fixing me. :-)

8:35 AM First patient of the day. Ah, clinic! This is why I am in medical school. Today I saw three patients: two women close to my age and a newborn. My clinic notes are improving each week and I feel like I'm starting to gain some familiarity with common medications. Next year will be nothing but clinical clerkships for me. I'm simply thrilled about that.

12:10 PM Apologize to a club president (I'm an officer) that I won't be attending today's guest lecture since I have a mandatory meeting for the Emergency Medicine class I signed up for. Snag a taco on my way out the door.

12:15 PM Emergency Medicine Elective lecture. This class includes 8 lectures and 5 skills workshops. I know that I'd like to work in small emergency departments in the future, and I thought this class might give me an idea of what I might be getting into. I doubt it will make much of a difference helping me find moonlighting opportunities during my 3rd year of residency, but who knows. This week was focused on immobilizing spinal injuries for transport. Last month I was certified in CPR for the umpteenth time. It's odd to realize that this skill I've been trained in since I was a teenager will actually be put into use as a clerk and a resident.

1:00 PM Lectures for second year students are scheduled until 4 PM. I'm so grateful that my school makes a video recording of all lectures. I feel like I only grasp about half of what is said on my first go-through. Fifteen minutes into my second lecture (while on slide 5 out of 60) I gave up on walking away with much this afternoon and pulled out my laptop to answer emails and to start this blog post. Yes, lecture is just that engaging today.

2:50 PM I'm packing up. I get my middle-schooler around 3:15 each day. We usually have about an hour together before everyone else gets home. Last year he was in a new town, at a new school, with his dad no longer in the home. Needless to say, it was a challenging year for all of us, but particularly for him. This year has been so much better for him. I'm glad that we get to have a little time with just to two of us. Today, however, was not one of those days. I had to drop him off (he'd rather not go along for the ride) as I headed to the high school to give my oldest son a ride to work. Since I have to pick him up, my other kids opt to go along for the ride and by-pass the bus. After all the driving is done, I get home around 4:30.

Tonight's agenda will include helping my budding author with her English paper, reminding my son that Khan Academy is much better at teaching physics than I am (though he doesn't seem to believe me), taking the youngest to the Fall Festival at his school, and maybe (fingers crossed) getting through the lectures that I missed when I left early yesterday and the day before. Just 90 hours until test #2!

The Big Four-Oh

Forty snuck up on me this summer. Well, "snuck up" meaning that it came banging on pots and pans and whooping and hollering. Yes, the month before my 40th birthday I cried. "I'm turning 40," I lamented to my daughters, "...and I'm getting divorced," sob, gasping for breath, "...and I know I wanted it, but it's hard and I'm old and feeling alone," deep inhalation with tears, "...and I'm so glad I'm in med school," quiver and shake, "...but it is just so tiring," gasp, "...and now my head hu-ur-urts!" This was met with awkward stares from my 18 and 16 year old girls. Did I mention I was driving at the time? We had taken a little girls' weekend. It was fun. It was girlie. But my last huzzah at being 39 was slipping away.

Now that I'm on the other side of 40, I can breathe a little easier. It happened. And I didn't die. And my ex-husband and I get along amicably. And school, well...school is restarting today, so who knows? My plan is not to let it get quite so tiring this year.

It's over...sort of

I took my final exam as a first-year medical student last Friday. It was an NBME shelf exam on micro and immunology, so that means that my score won't be released for another week or so. That's fine by me, as I'm certain I passed the course.

This past year has been a little like manageable insanity. Yeah. I have no idea what that is supposed to mean either. It wasn't easy. It wasn't unbearable. It kind of sucked. It was kind of cool, too. As I think about one more year of the "basic sciences" before I take USMLE Step 1, I get this sinking sensation in my gut. Really? More of this? Dang. I thought I signed up for a marathon, and somehow I ended up on a freaky 100-mile "ultra."

But, wait....there's more!

While 135 of my classmates are enjoying 8 weeks of summer break, I'm sitting in a meeting room with 14 other individuals who have opted to participate in a family medicine prep course. The downside is obvious: 4-hours of daily lecture plus additional clinical commitments, just like the regular school year. The upside is the opportunity to begin clerkships this fall instead of at the start of third year. Getting a head start on clerkships means that fourth year doesn't have to happen for us. All we have to do is give up our summers and add extra classes and clinical time to second year. Oh, yes, and commit to going into primary care. Some how, all of this struck me as much more reasonable 12 months ago. Twelve, long, pre-medical school, pre-burn-out months ago.

As tired as I am today, I'm not despairing. Mark my words. I will find time to hang out at the pool at least once a week. And I will consume my fair share of ice cream. Summer school might not be fun, but I'll do my best to make sure that summer is.

Overabundance

After a long and philosophical monologue about turning us into "independent learners," I asked a faculty mentor if "brought to you by YouTube and Wikipedia" would be printed on the bottom of my diploma. He just laughed. I did, too, in order to hide my frustration. Physicians are required to have an absurd number of continuing education hours each year. Believe me, I appreciate that independent learning is a part of my future. What I'm not such a fan of is paying tuition, attending lecture, and then feeling clueless over what to expect from the exams. (Yeah, yeah, yeah: there is more to life than the exams, but when you fail an exam, you kind of don't care about all that other stuff.)

Medical school is radically different from anything else I've ever done. As an undergraduate, I attended lectures regularly and took meticulous notes. I was accustomed to looking at the chapter headings, skimming through the material, and reading the summary at the end. Sometimes I'd even read the chapter and do the practice problems. It wasn't easy, but it also wasn't that hard to master the material. That's not where I am any more. It's almost as though some maniacal mastermind saw me speed-walking on a treadmill and thought that I should pick it up a notch to (oh, I don't know) a sprint. It isn't an issue of what I need to learn that is hanging me up, as much as it is the sheer volume of it all. It's a lot. Fast.

So when you are overloaded with gobs of information to process in a short amount of time, you know what you really don't need more of? Resources. Really. You might think that you need more resources, or that if you found the right resource, you'd manage your time like a champ. The problem is, in medical school, they will be flying at you from so many directions. No doubt--having excellent study materials is vital; having a virtually endless number of sources to draw from is overwhelming. Oh, but wait. Isn't an "independent learner" someone who relishes spending hours hunched over her laptop Googling "galactose-1-phosphate uridyltransferase" and reviewing as many resources as it takes until she has a complete understanding of how this autosomal recessive enzyme deficiency is manifest as failure to thrive in newborns?

Seeing as I don't have an innate knowledge of galactose-1-phosphate uridyltransferase deficiency, and considering that it is only one of the hundreds of enzymes I will need to know by the time I take my step exam in 12 months (oh, wow! I hadn't even realized I was counting), I'd like a little more direction than "you should Google it."

In med school, there is simply no way to cover in lecture everything that you need to know for the board exams. I don't think it is even humanly possible to know all of the material I will be tested on by the time I become a fully licensed physician. My take on it: if I do my best to swim in this sea of knowledge, I ought to get at least a little bit wet. There isn't time for me to sit on a rock and study a solitary starfish.

And this is when I appreciate (and curse) the overabundance of resources with which I have been blessed. It's actually a nauseating number of resources, really. Wading through all of it to figure out what works for me is a real time-suck. Maybe you are starting your first year, and you just happened to chance upon my blog, at a time when you were just wondering if you'd ever run out of study material, and that got you feeling a little anxious. Well, you are in luck, my friend! I'm here to let you now that you won't run out of study aids and your anxiety is legit. Maybe, just maybe, my experience might be instructive. Or maybe it will simply distract you from that 40 minute YouTube video you were about to watch on galactose-1-phosphate uridyltransferase deficiency.

First, a Confession and Disclaimer. I know that the capstone of the first two years of medical school is the USMLE Step 1 exam. I've heard about it. (Duh.) I knew that that was the biggy. Schools use their Step 1 scores as a way of saying, "We are the best!" I've heard the advice to study for Step with each class you are in. Now, you've heard it too. Hearing and doing aren't necessarily the same thing.

Anatomy. No getting around this, I really did learn more from YouTube than attending lecture or reading the textbook. Sad, but true. Of course, spending 20-40 hours each week in the cadaver lab certainly helped. I bought an old edition of Moore's Clinical Anatomy. I earnestly attempted to do all of the reading...for the first week and a half of class. The textbook might be essential for understanding the clinical correlates, but YouTube videos tie them together more concisely. And there are so many clinical correlations that this class bears little resemblance to the undergraduate anatomy I took five years ago. Naming all those parts? That's "first-order," my friend, and it's time to be thinking "second-order." It's not adequate to know the blood supply to the head. Instead, you should appreciate how a pimple in the "danger zone" can lead to a brain infection. Thanks, YouTube!

Of course, you can't do second-order problem solving without having a good grasp of what you are looking at. Acland's Video Atlas of Anatomy is a fabulous resource! It is like being in anatomy lab, without the smell, and with everything labeled. Acland's can be a little creepy to watch. A friend told me that he was sitting in a coffeeshop reviewing the videos and heard a lady behind him gasp. He wasn't trying to be shocking; he was just wrapped up in the insanity of being an oblivious med student. He appreciated the situation and switched over to YouTube. Again, there are always way more resources than there are hours in the day, so you can change from one to another without wondering if you are leaving something out. (Which, of course, you are.) There really isn't one or two key sources for great videos on YouTube. Dr. Preddy's anatomy mnemonics were fantastic for the upper limb and the neck. Peter J Ward/Clinical Anatomy Explained has excellent material on embryology. I also like material posted by TheAnatomyRoom.

Studying for Step 1? No. Simply trying to keep afloat. Good thing that Step is only 5% anatomy questions.

Biochemisty. Memorize the enzyme deficiencies that result in disease! Wish someone had told me that. I was caught up in memorizing as many pathways as possible and really missed the boat on this one. I thought the class would be similar to what I had as an undergraduate, and it really wasn't. It followed the same topics, but the focus was on clinical derangements. It seems like a real "duh" for me to say that, but it wasn't what I was expecting based on the lecture material.

I purchased Rapid Review Biochemistry and used it a little. I (foolishly) thought it was too disease-focused for the test. It was exactly the level of focus I should have had. It will be a dear friend as I prepare for Step 1.

Cell Biology. Biochem was a rude awakening in how I prioritized the material to master. Clinical correlates! Yes, there was plenty of good, old fashioned memorizing of what goes from where when. Only now it seemed slightly more obvious that I should remember the synaptonemal complex that occurs during the diplotene stage of prophase I during meiosis I since that is when oocyte development is arrested in the five-month old fetus until ovulation. Duh! That is clinically relevant. There is a ton of pure memorization in medical school. It's way more than I will ever be capable of processing. I'm breathing a little easier now that I have a better idea of where to focus. I also switched from taking notes on my computer (annotating the PDF electronically) to printing up six slides per sheet and actually writing out notes the old fashioned way. Marked up papers were surprisingly faster for me to flip through and review.

Histology. Our professors really rocked this one! The lectures and handouts were surprisingly comprehensive. When I came across a concept that was unfamiliar, Wikipedia and the class text generally sufficed to fill in the gaps. Connecting clinical correlates to what I saw on the slides was easier for me to memorize than simply seeing words on a page. Shotgun Histology on YouTube is very good, and pretty quick. Attending histology lab and discussing slides with my classmates was probably the best way for me to learn the material. This was the first time I began really reviewing lectures asking myself what three questions would a professor ask. Of course, sometimes the answer would be "something from this table of 20 items." You'd be amazed at how memorizing that table meant that I was really narrowing things down.

Even with excellent material from the professors, there is so much to learn that it is easy to fall behind. At the end of histology, I made a pact with a friend. Daily review of lectures together or the one who backs out has to buy lunch.

Physiology. Costanzo's Physiology is written with greater clarity than most and is only 500 pages. This is slightly more manageable to conquer in the 8-week block than the other recommended texts (which I kind of abandoned anyway). The daily review with classmates made a difference in getting the knowledge to sink in. I started using Picmonic to aid in the absurd amount of memorization. Review questions on Firecracker was frankly overwhelming...too many to get through on a daily basis, though worthwhile if you can fit it in. (Friendly reminder, single mom with six school-aged kids. It's a bit hard to fit things in.) PreTest review questions are an excellent way to identify weaknesses.

My end of block self exam (aka, NBME) subscores reflected my performance on the five systems exams I took during the block. We are given one day of study time between our last system (endocrinology) and the comprehensive exam. It simply wasn't enough time to review. I had intended to relearn the subjects I had done poorly in throughout the block by reviewing on the weekend, but with exams every 10 to 14 days, "free" time was hard to find. Gastroenterology was my strongest area followed by pulmonology. YouTube videos of Dr. West teaching the concepts in his book is the way to learn pulmonology. Abandon Constanzo and focus on West.

I finally started annotating my copy of First Aid, though I anticipate using my annotated Costanzo a year from now when I prep for Step. Step 1 became real in January. I think the sooner if feels real to you, the better you will be studying for it.

Microbiology.  This is when I finally got smart. My focus went from preparing for the class exams and focusing on Step 1. Professors inevitably give detailed questions that are unique to their lecture material, but Step 1 study means that I'm spending my time learning the most high-yield, testable concepts. Picmonic is very helpful for drilling in the unique properties of microbes. Of course, the volume I needed to learn for in-class exams exceeded the content they offer. That's OK; at least I know that I am focusing on the ones that I am most likely to encounter on the board exams.

MicroCards! These "flashcards"--which really aren't flashcards--cover just about anything you need to know about microbiology for Step 1. I just purchased First Aid for the Basic Sciences. Um, yeah, I should have gotten that earlier, though, honestly, when I was told to get a dozen books for each class that lasts 6-10 weeks, I just knew there was no way on earth that I could get though all of that. I've returned to Firecracker, but still hate it when it tells me to do 112 questions today. Hate it might not be the right term. It's more like I resent it. Bossy, know-it-all, over-achiever telling me that I need to spend 2 hours cuddled up with it. The board exam for this material will be given with the immunology exam at the beginning of June.

Immunology. Think I finally figured this out. We just started this content a few days ago. I need multiple and varied exposure to get this stuff in my head and so I watched a series of videos at double speed as a preview. Tonight I will do the same thing with a different series to give myself more familiarity so that the concepts in class don't sound so foreign. I have been doing PreTest questions as my final review before the exam. I plan on doing them earlier this time in an effort to identify key words as I delve into the material.

Less than a month until I am officially done with my first year. Can't believe I've made it this far.

Random Confessions of an Optimist

There is so much that is ugly in this world, which is exactly why I believe in finding the beauty. Sometimes that takes no work at all. I look up and find myself lost in the colors of the sunset. Sometimes finding the beauty requires a little discovery. "Discover," in my book, means "hey, that wasn't exactly obvious, was it, but look what you got now!"

I've been told that people who are optimists have their heads stuck in the sand. I've also heard guys (why does this seem more male than female?) proclaim, "I'm a realist," as though being connected to reality makes their dour outlook on the world more legitimate.

I'm a realist, too, and I really believe in being optimistic. I believe in dreaming because I know people who have given up on their dreams. I hope for the best because there is nothing more desperate than an individual who is hopeless. I trust in the goodness of others because I know how imprisoning it feels to living with mistrust.

My first year of medical school will come to a close in one month. Focusing on the good of this experience is what has gotten me through. 

My Med School Personal Statement

One of the most nerve-wracking parts of applying to medical school is crafting your personal statement. Schools use MCAT scores and GPAs as a quick and easy way to eliminate applicants. The personal statement is your chance to say, "Please don't toss me in the recycling bin yet." 

I really can't remember how many times I revised this essay. By the time I was done with it, I felt a combination of satisfied with it and sick of it. I'm posting this here as there are very few examples of personal statements for medical school applicants to read. My take on it was to emphasize the "personal" and to explain why medical school at this juncture in my life as opposed to when I was younger. All in less than 4500 characters.

 

Personal Statement

January days aren't supposed to be bright and beautiful, but this one was. The azure sky was a crisp backdrop to the dormant trees. The tall oaks reached heavenward, surrounding the lawn like a fortress wall. Their bare branches reminded me that despite the warm sunlight on my skin, it was the dead of winter.

The metallic blue coffin in front of me held my father's body. His diagnosis of cancer had come less than three months earlier, on Halloween. As a 14-year-old, I thought it was impossible for a disease to take my dad. 

Just the month prior, I sat at the foot of his hospital bed. "You know," I told him, "I've heard about people who got rid of their cancer. They visualized their bodies destroying all of their cancer cells, and it worked." Dad just smiled. His once thick, black hair was now thinning. His eyes were tired, his face swollen.

It was odd for me to be there, at the foot of his bed. I wanted to cuddle close to him, rest against his shoulder, talk to him, just as I normally did, but everything about the hospital room told me to stay away. The leads and lines connected him to massive machines. The wires and tubing looked too delicate to touch. Long before cancer took my father's life, the hospital had taken him out of my reach. 

As I headed off to college, I knew that a career in medicine was not for me. Three years after Dad's death, doctors and hospitals still meant shattered dreams. I chose a degree in the social sciences. I learned how the most primitive and intimate relationships we form early in life profoundly shape who we become. I sought to understand the human connections which influence how individuals respond to the human condition. Nothing was more fascinating.

The mother-child dyad had been a particularly intriguing area of study for me. I got married while I was a college student, and started a family. Once I became a mother, theory was tossed aside. Motherhood transformed me through the new roles that I took on. Even after my daughter was born, I found myself endlessly reading about the physical and emotional processes of childbearing.

Assisting a woman through her journey into motherhood was a way for me to integrate my personal experiences and my education. I became a childbirth educator and a doula (birth assistant). Preparing couples for birth and parenting, and attending births, reframed my view of hospitals. It became a place where I belonged, a place where my skills helped others navigate challenging and transformative events. Most significantly, I was able to serve as a bridge that helped patients stay connected to their loved ones despite the wires and tubing.

Working as a doula was the first time in my life that I felt the call to become a physician, and I felt torn. I had two small children at that time and a desire to have more. The lifestyle of a medical student seemed at odds with the lifestyle of a baby-wearing, breastfeeding-on-demand, young mother. The thought of working my way through the science courses was daunting. Medicine simply wasn't a priority.

Though I enjoyed my work as a childbirth educator and a doula, I wanted to do more. Becoming a midwife felt like the logical next step. The training was challenging both didactically and physically, yet it still allowed me to enjoy a balance between family and career. Working as a midwife has been immensely enjoyable. I still feel privileged to be at each birth I attend--rendering meaningful service to the families that I care for. That desire to become a physician, however, hasn't left me. I still have that drive to do more and become more, and that drive has grown. 

In October 2010, I sat down next to a 68-year-old woman at a professional conference. Some might call it fate, others might consider it a coincidence, but our conversation is something that my mind has returned to over and over again. The stranger who I sat by was at the tail-end of an FNP program. She asked me about my clinical background, and I shared that I was a midwife.

"You're a midwife?" It was more of an exclamation than a question. "I've always wanted to be a midwife! I want to start a midwifery program once I'm finished with my family practice classes." 

"Do you mean to tell me that the dreams don't just fizzle out and disappear with time?"  I laughed. "I've dreamed of becoming a doctor for the last ten years. If I don't do it now, does that mean I'll find myself applying to med school in my 60s?"

"Of course you will, and you already know that," she said in all seriousness. "If there is something you truly want, it will never go away."

Less than two weeks after that conversation, my big sister died unexpectedly. Sara was the one who stood next to me at Dad's funeral. She was the one who held my hand during the service. And she was the one who told me that we (especially me) were going to be all right.

At her funeral, I thought of Sara, Dad, and Mother (who passed away 10 years ago). I felt that two paths were set before me--one of feeling lost and another that told me to seize the day. Every day, Sara's passing reminds me that life is simply too short to stop moving forward.

Revived and Ready

Have I told you lately that my school rocks? Well, it does. I don't know how many first-year medical students get to take a Spring Break, but Texas School of Awesomeness just dished out this delight for the first time. (My 2nd-year friends were moaning the unfairness of the situation.) At least a dozen of my classmates headed off to Nicaragua on a medical mission. I headed off to tour my new home--covering over 1,000 miles in a week. Just days before the trip, I was tempted to cancel all plans and spend the week sleeping. But after heavy-duty, non-stop stress, I was utterly worn out and needed to put distance between myself and school. Literally.

Heading back to the books today felt a bit surreal. I updated my Firecracker set (I'm sure I'll write more about Firecracker later) to include only the bacteria that will be tested at the end of next week. After seeing 195 "review" concepts appear in my quiz queue, I just groaned. Oh, yeah, I am in medical school, and this is my life.

Fortunately, a friend invited me on a sanity break. We strapped on our skates and headed out to an abandoned tennis courts to enjoy the sunshine. It was the perfect time to wax philosophical on the intellectual and emotional beating that we lovingly call "school." (Remember? We want to be here.) The great thing about making friends who are upper classmen is that they feel your pain without a tinge of competition.

When she asked me how the last block went, I laughed and I told her that I passed. Why the laughter? I only needed a 54% on the final to pass, but even if I had earned 100% on that test, I still would have been 0.35% below the cutoff for "high pass." It's a little magical knowing I can't do that poorly on the final, yet I don't even have to try to do that well either. It's a bit of a sweet spot, really. I had grand hopes of "high passing" at least a couple of classes during the first two years of medical science. She confided with me that after missing "high pass" by less than one percentage point multiple times, she took a deep breath and let go. It's kind of funny how embracing the pass is the over-achiever's version of "embrace the fail." Funny, in a I'm-doing-my-best-to-prevent-an-ulcer sort of way. So far, I think it's working.

Best Laid Plans

Another block of classes is wrapping up this week. Physiology has been a whirlwind. The past eight weeks have covered all major systems in at a level of detail I never thought imaginable. Each section (cardiology, renal, etc.) has been taught by different professors, turning this block into a series of mini-courses with different lecture and testing styles.

After carefully planning my strategic attack for learning material this block, I managed to bomb the first two tests. Luckily, I'm adaptable and changed what wasn't working for me. Of course, the struggle this entire year has been trying to figure out what actually does work. My last two exams went well, so maybe I'm onto something. This week, however, has been a deluge of hormones as we've gone through endocrinology, and I'm not feeling too confident going into the exam on Wednesday. My confidence is even more wobbly when I look ahead to Friday. Our final exam is (once again) a national shelf exam and I'm feeling the need to actually learn all of the concepts I did not grasp from the first four weeks of the block. Wish me luck!

An Urgency for Living

A friend of mine died yesterday morning. I just found out an hour ago while checking Facebook. She was diagnosed with breast cancer four years ago at the age of 37.

I really don't know for certain if death has stepped into my life more frequently than the typical American 39-year-old, but it sure seems like it. I know that it is a much more familiar acquaintance of mine than it is of my classmates. And I am certain that I will rub shoulders with death much more frequently as I move through my medical training and start my new career.

For Jason, Floyd, Johnny, Nell, Janice, John, Sara, Brianna, Georgia, Marissa, and Annika: thank you.

Reality Check?

I've just wrapped up two weeks of fairly intensive studying followed by my first physiology exam. The new semester brought with it optimism and renewed determination to get it together and stay on top of the mountain of information. I've tried to be kind to myself by engineering a little success. At the conclusion of last semester, I made a pact to study Monday through Friday with one of my friends. The daily accountability has helped me not get buried. Furthermore, I negotiated a most-agreeable weekly tutoring deal with my favorite brainiac. You'd think I'd be set, right? My test score indicated otherwise.

I didn't realize that my new Determination would bring her side-kick Distraction along. In light of all that is going on, I honestly feel like Distraction does have a legitimate claim to some of the real estate in my head. The problem is, my limited ability to concentrate seems to have evaporated, leaving a salty residue behind. I feel like my mind just isn't working like I want it to, and that leaves me more than a little frustrated.

The exhausted feeling that set in on the third day of class has become firmly entrenched. The night after the exam, I slept for 12 hours straight, followed by 9 hours the next night. But the exhaustion is still there. Everything seems to just take longer for me to grasp. It's like I'm part of some bizarre sleep-deprivation study with the subjects being periodically tested. But this Exhaustion isn't purely an artifact of sleep-deprivation. I'm not certain, but I've got a suspicion that Exhaustion and Distraction are in cahoots. Determination doesn't even seem to realize that she's being played.

So today I did something my ego really, really, really did not want me to do. I ratted myself out. I went to the Office of Student Affairs and sat down with the educational counselor to talk with her about all these little Distractions in my life. The divorce, and all that comes with it, is my choice. But that doesn't seem to make it any easier. She pulled up my record and reassured me of how "solid" I was academically. She praised me for keeping so many plates spinning at once. And then, she just listened. It was somewhat cathartic (is that an oxymoron?) to give voice to my worries. By the end of the visit, I felt like I had myself pretty pulled together, but now it feels more like I just sloughed off a newly formed scab.

I don't regret my decision to end my marriage. I have not missed my husband at all since we've separated. I also do not regret my decision to go to medical school. Every day, I feel privileged to be where I am. Yet it's humbling to admit how utterly difficult it is to go through these two things simultaneously. That sounds so silly, doesn't it? No-duh it's hard. Thanks, self, for the reality check.

Exam Haiku

 Sleep, stay from my eyes

Quickly poring over books

Testing in the morn

The Grind

Is it really possible that I've only been in this new block for three days? I already feel worn-out. I'm nowhere near information-overload, but it certainly does not feel like I've had a two-week break. What happened to the rest and relaxation I was anticipating?

Perhaps my current state of exhaustion has less to do with school and more to do with the fact that my vacation was spent settling into the house we moved into back in August, getting my college freshmen ready for her second semester, negotiating a contract to sell my home in another state, and creating new holiday traditions with daddy out of the picture. Yeah. I think it's more that.

Good thing tomorrow is a new day.

All Wrapped Up with a Bow on Top

Wrapping up the first semester of medical school is a beautiful thing! The hustle-and-bustle of Christmas ain't got nothing on prepping for the end of the block. Honestly, this was my least fussed-over Christmas ever, and I kind of liked that. While shopping, a cashier would cheerfully inquire, "Are you all set for Christmas?" and I would just as cheerfully reply, "It's gonna come whether I am or not." It was good to let go of that worry. Too bad I had other things on my mind.

Our histology exam was one week before Christmas, followed by a comprehensive biochemistry, nutrition, cell biology, and histology final two days later. A friend and I spent the day before the histology exam going through the 30 lectures and discussing what we thought were the top three to five testable concepts from each one. We parted in high-spirits and I rested easy that night. It paid off! I scored in the high 80s on that test.

The first couple of hours after the histology exam felt wonderful! A final exam grade of 65 would have been sufficient for me to pass the class with the required 75. I felt confident that it was well within reach. But then something happened. I don't really know what it was, but all I could think of was how poorly I had done on the biochemistry test. I tried to engage my rational brain. I knew that there were dozens of people who did worse than I did on that first test. I also knew that it was unreasonable to think that they poured themselves into doing well in the second half of the block while simultaneously relearning everything they did not master during the first half. Of course, that rationality did not do me much good. I was a mess.

I can't really put together everything that happened on that study day between the histo exam and the final. I watched some videos, did a few practice questions, looked at high-yield study sheets, but mostly kept trying to keep myself from freaking out. It was not a pretty place to be. But good things sometimes come from being in dreary situations. I finally saw how my approach to studying was out of sync with how they teach and test in med school. Silly, isn't it, that right before my final I exclaimed, "Oh! I've been studying all the wrong stuff!" A light went on. And while I wish that light had gone on a few months ago, I'm grateful that it only took one semester of feeling intellectually beaten-up to get it. That night I went to bed realizing that it was too late for me to make much difference on the outcome of tomorrow's exam, but early enough to make a major course correction in how I approached the rest of my schooling.

And my final? I got an 89. It's easy now for me to say that my anxiety was over nothing, but I know better than that. My New Year's resolution to "do better in school" is a tad more educated with significant insight into how to make that happen. Here's hoping that I wrap up next semester with a little more sanity.