Conventional Wisdom from Hot Urologist: More Than a Board Score

Months and months ago, I walked into the same Starbucks on City Avenue at 6:15, just prior to giving a pap smear for the first time to a volunteer patient (true story, god bless that women's soul, amongst other things).  It would be the day I first encountered unnaturally hot, super thick-blonde-haired urologist from Einstein.  I didn't know his name (now I do), but we talked for a moment. He was in his fifth year of urology residency, something I learned later was a polite way of saying "chief resident" without shoving it in your face, like when people say they "go to college in Boston" but we both know what that means.
H.U.: "Are you a third year?"
VW: sheepishly (<<<----not entirely sheepishly, I just like the opportunity to use that word), "uh, I will be if I make it through this year."  Two can play at this 'guess my actual position on the medicine totem pole' game.   Actually mine was pretty obvious.  The short coat always gives it away, and I'm pretty sure I need to pack on 10 lbs and lose the makeup before I start to look like a resident.
H.U.: "Second year's rough. Boards.  It gets way better though; everyone tells you that and it doesn't really mean anything but you'll see."
VW: "Cool, I'll hold you to that when I come work for you."  wtf?  God VERONICA YOU ARE SO CREEPY RELAX.


Fast forward half a year, and hot urologist was right, after boards it DID get a lot easier. In a way not unlike the Kubler-Ross model of grief, I went through five stages, give or take.

1. Denial:  I don't buy it.  There's no way an 8.5 hour exam can be all about endocrine and Calcium.  There's no way.  They have to have been secretly asking about chronic myelogenous leukemia or polycythemia vera.  They wouldn't make an all endocrine test.  That's crazy.  No.

2. Anger: WHO MAKES A USMLE ENTIRELY DEDICATED TO ENDOCRINE.  WHY DID I EVEN STUDY ANYTHING ABOUT VAGINAL BLEEDING. HELLO, WHERE WAS ALL THE MICRO?  DO WE JUST NOT CARE ABOUT STAPH NOW?  YEA, EVERYONE, JUST SO YOU KNOW WE DON'T GIVE A RATS BEHIND ABOUT ANYTHING REMOTELY APPLICABLE TO MODERN DAY MEDICINE, OK. This is the worst.  I hate everything.

3. Bargaining: "Hey God, it's me, Veronica again.  I swear, I will literally join the convent and dedicate my life to you if you somehow make the Prometric testing center explode without human casualty during this exam and accidentally rig the system to give me >240."

4. Depression:  so little sleeping, so much ice cream, lots of nervous "hope I'm a doctor, hopefully, ha ha" jokes.

5. Acceptance:
Anyone else: "How was USMLE/COMLEX?"
Me: "Awful, I wanted to die.  Nothing you prepare for is on there. But in general pretty okay!"

I digress.  So here I am, post-boards, pre-score, but emphatically, post-boards, waiting for my latte that is probably the reason I have a hard time budgeting my student loans, and through the doors saunters in Mr. Hot Urologist Long Coat. But before the costume even gives it away, I think, God, that guy looks familiar, and I go through the mental forensic profiling match I keep in my head.
1) That guy is from Tinder.  NO. (It was a dark time when I became newly single). We don't like Tinder.
2) That guy is Hot Urologist.
3) Dude, Hot Urologist is on Tinder.  Yikes.

I'm sure he sees this moving montage/algorithm on my face as clear as day, so I take my thoughts elsewhere.  I read creepy like white on rice. Anything, think of anything.  Uh, puppies.  Campylobacter. Trisomy 18.  Scrubs Season 5 and how disappointing it was.  Laundry I didn't put in the dryer.  What am I going to eat in 6 hours----

H.U.: "Today's my last day of residency."
VW: "Exciting!  Good for you."  It worked. He's not on to you.
H.U.: "Second year, right?"
VW: "Actually, third year.  I made it out alive.  Well, [cue the self-deprecating defensive humor], I guess it depends.  I just took my boards."
H.U.: "Awesome, they're no joke.  What do you want to do?"
VW: "I guess it depends on my score."

And as you might have guessed it, the crux of the moral is manifest here.
Hot urologist vigorously shakes his head; I can tell he's bordering upon a "tsk, tsk" and finger-wagging.
"I didn't ask what you got, that doesn't matter.  What do you WANT to do?"

And before I begin my diatribe to explain that, yes, in fact, I believe my score dictates a lot of what I can and can't do, I also give myself some pause.  A lot of what I "can" or, perhaps better put, am academically qualified to do is premised upon a score.  But Hot Urologist is right, it's not the only thing, and while it's the most standardized way, it isn't the only way.  So I answer him truthfully.

"I want to do Internal Medicine.  I like adult medicine.  I like a little bit of continuity of care, but I'm afraid I might not see as...'ill' as I'd like with just Family, although I considered that too.  Honestly, gun to my head and I had to decide today, I want to be a hospitalist. It's my dream.  It's what I want."

H.U.: "You poor bastard, you'll be worked to the bone until you die/retire.  Good for you.  It's not just your scores, don't let anyone tell you that.  I'm telling you that.  Good luck."

And part of me hopes he's truly right.  Not just because his frankness makes hot urologist even more mysteriously attractive, and not just because I feel it's a fallback excuse for substandard performance, should I not get my target score (read: passing.  In case you haven't noticed over the past two years, a lot of my targets tend to gravitate towards making sure I don't fail).  Mainly, I hope he's right because, in much the same fashion I deliberately chose to apply to and attend as Osteopathic College of Medicine, one that preaches and practices looking at the "whole" patient instead of just pigeon-holing their problems into symptomology (made that word up, don't try to google it) and differential diagnoses, I wanted to be looked at wholly, and thoroughly, and completely too.  I want to be seen as competent, which hopefully is substantiated by my boards, but irrespective of those, I want my future attendings and residency programs to see me as Dr. Williams, the resident who is so bothered by not knowing the why  of your presentation that I'll let my OCD take me to the depths of Harrison's at home and I'll look it up until I can teach you all about acute appendicitis.  I want them to know I am a trained painter who loves portraits, because of the attention to detail that is required, and because I genuinely feel art and it's application on a painted canvas is a way of telling a story about someone, and I am so interested in everyone's story.  I want them to know I run miles and miles not because I ever give two hoots about my weight, but because I do all of my thinking and problem sorting when I run, and I believes humans were meant to move.  And most importantly, I want them to know that, although medicine was a dream realized a little later than most of my peers, I still, every day, want to be doing it.  I want them to know that I would sleep in a car 5 summers over and over again.  I would remediate physics, again, for the third time, to be here. I would overdraft my account by 20 dollars and cry into the Washington Mutual phone again and again and beg for a fee waiver just to pay for another AACOMAS application. I would fail Dermatology in medical school again, study for 1 week straight while everyone was already on spring break, and never have a sense of bitterness about it, just because it meant I could keep going, and now, I know Derm like nobody's business.

That, hot urologist, is what I want you, and all attendings just like you, to know.  I hope you're right, but really, I hope you don't even need to be.

Navigating Limbo of (1/2) DO; Reintegrating Into Society

I often joke about my personal frequency of existential crises as a shiny new third year medical student. As if, in a way, publicly acknowledging them makes them punitive, a type of correctional reinforcement for myself to stop being so petty and get over myself, as if what I have done in the last two years even remotely has any bearing on what I do when I actually get out to do it: in a hospital, with patients who are not robots, with preceptors that are a little less forgiving and rightfully more demanding.  And in a way, many of my cynical humors are well-intentioned, but they are nonetheless pervasive.
I spend a good deal of time losing sleep, partly due to a regrettable $99 mattress, the rest likely attributed to this feeling of self-doubt, that, like these springs with lost recoil but still find some way to jab between every individual rib, remains unrelenting. Keeps me awake, keeps me unsure, keeps me anxious when I would rather be dreaming.  I urge you, at this moment, to suppress any immediate feelings of pity, or eye-rolling annoyance of “god-this-naïve-young-half-doctor-who-hasn’t even had the chance to nearly kill someone yet, let alone be publicly crucified for not sending the fax correctly.”  Mainly because that’s not the point of this little testimony. As most of my medical school musings have shown, I write when I need to think aloud, when my hands do the sorting for my mind. That, or I paint, but I don’t feel like getting my hands dirty at 4:30 in the morning.
But I write this piece predominately because I find it imperative to articulate what a lot of people (presumably) in my situation have felt a million times before, but have had a difficult time conveying to whomever asks; those who want answers, even out of trivial benevolence.  To clarify, I mean our families, or our friends, who “want to know how you are doing?  Where have you been?  Tell me about what’s happening in school?  When do you get your scores back?” and so on.
Again, please don’t think I’m here to lecture about the necessity of “leaving us alone” because of the “gravity of what we are doing,” or how sitting here in a 2 hour didactic followed by a lesson on how to do a venipuncture is clearly so much more taxing on my brain and body than your 9-5 and how could you possibly understand. No, in fact, quite the opposite. But it requires patience from you, as the reader, so bear with me.
I write because, I feel that it is hard, even now, to accurately describe the type of distance you feel as a medical student: between you and your peers, between you and your material that you have not quite drowned in, but somehow keep your nose above water, between you and your faculty, who in some ways, can no longer help you, and more importantly (for me), between you and The Outside World-your friends, the general public, the romantic partner.
It is a distance not so easily remedied by merely interacting with colleagues or friends, by active club membership or a prescription of SSRIs, or “positive thinking” or yoga or alcohol or insert-your-favorite-recreational vice here.  Again, the undertone of this isn’t meant to solely imply melancholy, but rather, to show that some of it is natural, woven inherently and somewhat implicitly, insidiously into the nature of a medical school curriculum.  It is partly unavoidable, transient, but most certainly, present.
Like every story deemed worthy of sacrificing valuable REM to, this one has an impetus.
At a dinner with a young man not long ago, I tried to describe what it feels like to truly sit back and realize that you are on a career trajectory that has decided much of your “fate” (I choose this word lazily), for you.  By that, I don’t necessarily mean specialty….but then again, yes, I kind of do.
From the day you begin medical school, a 2 year long calendar that most of your peers don’t know how to access on Nucleus is available for you to view.  From there, you see every term’s beginning and end, every holiday you’ll ever get off (and after 2nd year, will never get off); every fee deadline and every grossly inaccurate loan disbursement approximation.  You begin as Student Doctor OMS-1, and can essentially see all the way into the future, pending no major failures, psychological breakdowns/leave of absence, etc. And you know what to anticipate: the hard work, the certain addiction to some caffeine or other stimulant, the late nights and early mornings, the overreactions to B’s and C’s as a first year and the complete turnaround attitude of being totally underwhelmed, thinking “who cares JUST SHUT UP ABOUT GRADES THAT DON’T MATTER AND LET ME STUDY FOR BOARDS FOR GODS’ SAKE”-this monotony and anxiety that prevails in second year.  And then you take the GREAT EQUALIZER: the COMLEX, the USMLE, or both, if you can tolerate 16 hours of testing, and then: so what.
Then you wait.  And ironically, this tangent has nothing to do about awaiting scores. Like anything else, I know they will come, and will be set to some scale that dictates what doors are closed and which others are opened, but at the end of the day (the year, the years, the year 2018), I still get to be a physician: the ultimate dream actualized.  On top of that, I get to be a Teaching Fellow.  So not only am I still seemingly typing without purpose, I’m nearly complaining when I should be grateful. The point is coming, don’t worry.
But it is more than that.  It is trying to tell whomever sits across from you at this sushi restaurant, or at home, or on the phone, that in many ways, medicine forces you to learn a language that now, only a few of you speak.  Your experiences, whether you like it or not, predominately revolve around you and 200-something people just like you, doing what you are doing, all the time, 24/7.  And while the gratitude never, ever goes away (hopefully), sometimes something else does-some part of you-and I believe you would be hard pressed to find a medical student who disagrees, if they truly took a moment to consider it.
Imagine actually trying to care about your future in the ways most “normal” people do.  Imagine trying to convey to someone that you’ll be leaving for 4 years (now 5, because you’re clinically insane and enjoy pre-doctoral fellowships), and maybe you’ll come back, or hey, maybe not, it’s really up to “THE BOARDS.”  Or what it’s like to pack your vacation so full of things to do in 14 days for the one and only year you’ll get it that you spend more time allocating each’s days activities amongst different parties of friends/family that you aren’t even sure WHAT day it is, and in some ways, it confers this metallic, bitter taste to your mouth that is synonymous with “vacation” when all you wanted was to melt into nothingness without reprimand for being selfish.  Whether or not you are actually chastised for this behavior is besides the point; it’s the nagging Catholic guilt that tells you what you ought to be doing with and for others, instead of compulsively looking up Expedia flights to St. Martin because, god knows how long your grandmother has left, or that you should probably go back to the West Coast to show some appreciation to the person that bailed you out of all those college overdrafts.
Or what it’s like to tell someone on a date that there is no permanence to your situation, necessarily.  That you would like to stay here, but things are unclear.  Or that you would like to move there, but, I mean, this is just a date, or you are just a significant something or other, and this is by no means implying that every future decision you make regarding residency depends upon them, but it certainly doesn’t factor them out, because, well, you are a liar and a fool if you think the choices you make in life don’t, in some way, consider the beneficence of others (but moreoften than we would like, the beneficence of ourselves). The heart is greedy, and in a way, that’s a good thing.  If every decision we ever made was purely clinical, truly devoid of passion and fervor, we would be excellent diagnosticians, but incredibly poor practitioners, nay, artists, of medicine. All talk and no flavor.
But for a moment, imagine the guilt you might feel when you have so little to offer to the conversation of a ‘normal person’:  how everything you do, actually, yes, is in fact about you, and that you would love to hear about your friends’ wedding, but you haven’t slept in three days, so maybe she could email you?  Or how, on this date you’ve had for the 10239102380th time you just want to say, “I have made a very definitive decision to practice general medicine because it affords me the flexibility to work wherever, because, no, I actually do not want to be an unmarried surgeon in rural KY at an elitist program.  Because, no, that would never make me happy.  Give me all the general medicine, please.” But, you don’t, because that’s not what normal people talk about. Because it would add this unnecessary solemnity or intensity to a situation that is inevitable, a conversation that always comes up but is almost forcibly avoided. So what do you talk about instead?  What good acting skills do you summon from your ironic Bachelor of Arts in Theater to pretend like you can engage the general public?
They talk about what’s on TV on the cable you don’t have; they discuss what their kids are doing now in school and you nod your head ‘knowingly,’ pretending like having done a rotation in pediatrics makes you equally qualified to listen to this.  You want to FaceTime your friend, but by the time you pick up the phone, you realize it is now 5:50AM, and the last time you went to bed was now, two days ago, and you need to go to the gym, and take a Xanax, and read OMM because you have one Board left.  And it’s funny: none of this is an impossible, monumental task.  None of it.  It’s a lot, sure, but not impossible.  But what it is, is isolating.  And although it is just part of the routine, don’t let anyone lie to you and tell you otherwise.  How you navigate it is a personal choice, and some days it is so easy to put it aside and hop on a plane and forget all about it, and other days, it will be the reason you write a breathless essay about it, on the gravity of a situation that is very manageable, but nicely packaged and sequestered far from the outside world, behind a lot of books and laptops and short white coats. I wonder, when I finally put on the long coat, if I will muse about this and laugh that I ever let it bother me, that it ever kept me up at night, or rather, if I will just force myself to forget about it.  I wonder.

evidence of life: post boards, with Kelsey being a human again, with my fellow fellows Kevin and James, and post gyn skills with Grant, who is not blushing at all.

Primary Insufficiency: being enough when you feel less than

I must have started this post 4 or 5 times in the past 3 months and somehow couldn't complete it.  It just wasn't the right time, I told myself.  There were no major life-changes, no astronomical ups or downs worth documenting, nothing out of the ordinary.  Getting by per usual, I felt that the second I sat for my exiting final for a class worth next to nothing (unit-wise, not life-lesson-wise), I had already begun the next. GI blended into RGU, Surgery somehow haphazardly thrown in the mix, RGU blended into the world's shortest break, Sunday of break turned into Rheumatology, Rheum somehow became Endocrine, Endocrine gave way to Dermatology.  And in the midst of it I studied per usual, I ran per usual, I sighed heavily per usual and ate my way through a hundred kit kats.  I signed up for the COMLEX, and then the USMLE.  I ran a couple races, painted some new pictures, saw 1093120983102983120398 people on Facebook get engaged (c'mon guys.  Where are all the Halloween engagements.  WHERE?), logged into Blogger, but couldn't type.  I just felt robotic; content, okay, normal, complacent, surviving.  It felt familiar, kind of like last year.  In fact, exactly like Winter of last year.

But then I did something stupid, or rather, just different.  I agreed to attend a holiday party the evening before my Endocrine final. In my mind, this was perfectly logical.  I had studied harder than I usually do.  I was doing COMBANK questions like I would die tomorrow and somehow still be charged for my subscription. I read BRS and consulted faculty and talked through stuff with people that knew better.  I was ready, and so, I would take the night off, and actually sleep.

And I DID do just that.  I had drinks and was merry and took pictures and left my notes at home.  It was so weird!  I've never done that.  And yet, I couldn't shake the feeling that I was ready.  I had, somewhere in my deep psyche, convinced myself that no matter how much I had prepared, I wasn't ready.  I would never be ready.  I had made a mistake, somehow, enjoying myself.  And I got out of my friend's car at about 10PM, walked up the stairs to my apartment, went to brush my teeth, and something about the toothpaste or my reflection or seeing that it was close to the next day just made it all go downhill from there.

It was so weird.  One second I'm totally fine, face made up and hair flat ironed and I'm relaxed (buzzed?  Pie-coma? Confident?) and then I'm just a mess, sobbing into the bathroom sink.  Like, a scary sobbing.  The kind where if someone walked in, maybe they would have thought a family member just passed or that they cancelled the Blacklist or I received news about malignant melanoma.  But that wasn't it.  I just started crying like a 14 year old broken-hearted girl, and I couldn't stop.

Internal Monologue Veronica said "get a hold of yourself, woman.  What is your problem.  Crying just makes your eyes puffy.  Stop feeling sorry for yourself.  Relax." So maybe 30 minutes go by and with some textual coaching from Mike, everything wraps up nicely.  I can breathe.

So why did that happen?  What snapped?  This was crazy.  That was crazy, irrational behavior. But I realized, or more accurately, have come to realize that perhaps the biggest problem that plagues my day to day existence is me and my lack of self-confidence.

To be "ready" for something is such an uncomfortable and foreign feeling.  I'm not trying to be flippant or employ the humble-brag here; it's true.  I have lived 90% of my post-high school academic life convincing myself that I am the underdog: the under-performing, but high-potential student with the nontraditional background who peaked in high school as summa cum laude and that was it. The starving artist, theater-major who has never taken physiology (<--- true story), about to take a test on Essentially the BODY 101 and ALL ITS PHYSIOLOGICAL PROBLEMS IN YOUR BRAIN AND ADRENALS, DUH, and here I was literally having a mental breakdown that I felt ready.

Doesn't that sound crazy?  I live under the assumption that I am never ready, that I have to maximize every conscious moment because I will never perform on par with my peers and if I do, it must be a statistical anomaly.  And it's funny because in retrospect, I reinforce that.  Someone says, "good job," when I get a B and instead of thinking "hey, thanks," I almost immediately revert to the logic of "well, I really got a C- but that extra 8 questions of lucky guesses really put me undeservedly over my expected performance."

So while I wept like a pathetic delicate flower over my sink, these were the thoughts that permeated my mind.  You can't be ready, Veronica.  You are not allowed to be ready.  If you think you are, you are disillusioned. And disillusionment leads blindly to failure.  And thus, you are failing.  And it is weird that you have not failed out of medical school yet.

I'm not trying to justify the validity of that way of thinking.  In fact, quite the opposite.  As medical students, we are already high-achieving.  Motivated, smart, intellectually curious, whatever.  We strive to be the best in many avenues (some beyond or even excluding the classroom) because it justifies why we are here.  Some 7000-8000 applicants, some 600-800 interviews, some 400 acceptances, some 5% chance of getting accepted, pending you even meet the most basic criteria, which after all, isn't really that basic.

I remember applying to medical school in post-bacc.  I sat in the library at California State University East Bay, almost ashamed to be typing into my secondary to Pacific Northwest University of the Sciences that I had a degree from UC Irvine, a school that recently ranked FIRST in the US and fifth in the world among universities less than  50 years old by Times Higher Education (shameless plug), but here I was, in a state-school post-bacc, because I obviously couldn't do justice to the prestige of the degree that preceded me.   And it was weird that this insecurity still carries over, even after 4 acceptances, multiple interviews, the rare and incredible (really, almost unbelievable), first round luck of med school applications.  It's like sometimes, I really can't believe I am still here.  That I have hung on and not been given the boot by the very institution that said "we believe in you."

This is my opinion, but I think an easy mistake to associate preparedness with a predictable outcome; more specifically, a medical student that feels ready expecting a 100% on an exam.  Self-imposed pressure aside, you can be as ready as you want to, but medical school is medical school.  It's not meant to be easy.  You can alleviate a lot of the burden of uncertainty by preparing, by studying, by practicing, but you are not in total control of the outcome, just most of it.  Being "ready" is not synonymous with "getting A's."  I don't need to go into the factors that determine test-taking success; we all know how that works by now.  But we forget to let that uncontrollable 10% be variable, we don't like to give up the control.  In a similar way, to feel prepared and simultaneously know that there was nothing more to do was so uncomfortable to me, it made me viscerally ill. 

For the record, I did just fine on Endocrine (Derm was another story, ha).  But I convinced myself I wouldn't, in spite of my hard work.  I feel that we all do that, to some degree. Some of us are more vocal about it than others, the rest of us just wear waterproof mascara.  The point is, you do what you can, as efficiently as possible, and you leave the rest to the test.  It's not meant to be easy.

I would bitch to my mom in high school about how I was always in jeopardy of losing my Varsity spot for Cross Country. "If you want to win races, Veronica, just run faster.  It's that simple.  But don't expect to win every one.  Run faster, but you can't become an Ethiopian Olympian overnight."
Obviously this statement is laden with stereotype, but you get what I'm saying.  Do your best, and if you don't like the results, try something harder, something different.  But don't freak out if you're not first.

In the meantime, I've been preparing for a couple marathons, both on foot and in my brain.  I am taking COMLEX May 29th, and USMLE shortly thereafter.  My reasons are my own, and everyone will have their own opinion as to whether or not to take both.  But ultimately, I want choices, even if it only means 5 more program options.  I've never let money get in the way of my dreams, and sometimes it meant living out of my Hyundai or not eating anything other than canned peaches and working 3 gross jobs, but I don't care.  So I'll keep you posted on when I lose my sanity (but hopefully not).

Lastly, I leave you with art I've been doing, just because :)

Can Being the Best of the Best Make Us Collectively the Worst? The happy medium in diversity, unity, and empathy.

Imagine a class where someone educated you in the ways of socially appropriate action, emotional intelligence even.  A course constructed in a Socratic fashion, public forum question and response format whereby the prompt is usually always something along the lines of "A patient presents with xyz health concern confounded by xyz social and environmental factors, all muddled amongst this xyz moral dilemma woven into this vignette. As a provider, you use your ethically sound judgment to consider a solution that will simultaneously CYA and also be impressively upstanding

Do you:

A)Choose the distracter answer because you weren't paying attention to the entire last 50 minutes

B)Choose choice B, because it isn't choice A and you really don't care

C)Choose C, which uses recognizable words from the lecture and seems neither radical nor vague

D)Choose D, which has carefully crafted semantics with an emphasis on one word that renders the answer  technically invalid but is appealing nonetheless

And such is the redundancy of Medical Ethics and Law, which is not so much boring just because of the subject material and of little fault of the instructor, but maybe because we think we all just know better. 

We shouldn't have to hear this, be subjected to the make-believe gravity of a hypothetical situation of ignoring patient autonomy in this vignette about a ventilator and Health Agents and etc, because of course we would do the right thing.  Of course we are above the obvious flaws of inattentiveness, or negligence, or carelessness.  Of course we would, when put in a situation that is more than about being a good diagnostician or shot-giver or band-aid applier, use both common sense and emotional acuity and of course we would never make a novice mistake like not consider a patient's rights or blow off their caregiver or make an insensitive joke because they don't speak English and just like we suspected, aren't compliant with their Metformin and are huge and now borderline comatose. Of course, we are better than that.

But sometimes, amidst the groans and eye rolls and gossip and general apathy that will invariably come with classroom boredom, the drone of laptop typing and neurotic Facebook skimming and the creeping depression that seems to coincide with shorter days and colder weather and a nostalgia for summer,  I have to wonder if we are as emotionally, empathetically aware as we staunchly claim to be.  If we are as 'of course' as we'd like to think.

And while I don't doubt the selflessness and capacity to give that we all have to work as future physicians, those whose lives and decision-making revolves around their patients, I think we often are guilty of forgetting.  I am; I have forgotten many times that I have chosen a profession that is not always all about me. 

Think about what people say, or said, when you told them you were going to medical school.  Put aside, for a moment, the initial shock or even expectation, and consider the things you were told, verbally, would happen to you.  For the most part it was optimism and excitatory support (for my mom and grandma, probably a huge sigh of "thank god, she has a future beyond street performance and painting"), but you would be hard-pressed to find a matriculate that didn't say they weren't warned about how hard it would be, about the trials of exams and late nights and lack of sleep and miscellaneous debbie-downer-word-of-wisdom doled before they packed their bags for their 4 year journey.   And yea, so much of that is true!  I do stay up late, I do take exams (and hopefully pass them), it is hard, and it should be, and I don't sleep very much, unless it's an accident.

But always implied with those ubiquitous debbie-downerisms was the expectation that this was something of a bold sacrifice, an acknowledgement of accomplishment but also one of understated heroism: you, Chosen and Accepted, one who bears great weight of academia and endures the cold hard winter of caffeine and perpetual standardized testing all for the selfless fee of 250,000 dollars.  For a moment, you are recognized and reaffirmed that what you are doing is not at all about you, because it honestly sounds more sadistic than it does a fun new adventure, so you must, you have to, truly want this for some higher purpose than just the social recognition, the embroidered credentials on a white coat. Right?

But consider this. You've made it in, you are part of the crème de la crème, walking and learning amongst the finest and brightest from the land, collaborating and supporting one another in a 200-person sized medical paradise, compelled by the competitive atmosphere but all looking in the same direction toward the same selfless goal: to work for the betterment of the health of our communities, to advance in science and education and technology.  Of course.

And for all of those virtues and necessary benevolence that got you here in the first place, no one is immune from gossip, jealousy, pride, or self-interest.  As a whole entity, medical students are intelligent and motivated, successful academically and to some degree, socially, at least according to our AACOMAS application or preliminary interview. But like anyone else, we are subject to the same baggage, frivolous drama, propagating or feeding into slander or whatever. We have physiologic and psychological urges like everyone else; we do what we want and say what we want without thinking of the repercussions.  Big surprise, this is nothing new.  Most certainly, we are not saints.  But what we easily forget is that although we don't wear the big hat yet, we do wear the short white coat.

To most people, this is the universal sign of medical gumshoe.  The bottom of the totem pole.  The all-too-clean, too-crisp, awkwardly boxy reminder that we don't know enough just yet; we are in practice, we are mistake-makers, and in a sense, the short white coat serves as your scapegoat, your loophole from too much reprimand and finger-wagging.

Underneath those short coats are hundreds of applicants, many of which are chosen specifically for being "statistical outliers,": not just the intellectually competent, but the non-traditional, second career applicant, the impressively devout and human rights activist, the insane prodigy published in nine journals, the Big Ten athlete whose medical school journey was an afterthought.

And this very eclectic social milieu, seemingly homogenous with a sea of short white coats, creates a bit of a dissonance from one another, I think. Just how interesting each of us is can be, in a sense, a conflict of interest. I would venture to say 99% of us want the same thing: to make a noticeable, if at the very least positive, contribution to healthcare, in whatever capacity of specialty speaks to you.

Of course.

But what is most interesting to me is how often we fall back on our personal vices, our status of "short coat" as an excuse for making our poor unprofessional behavior admissible. We maintain the perpetual student attitude of "not my fault, not my problem, not yet."   We insist that, of course, when we graduate, when the time is right, we would do the right thing.  Of course  we know that treating one another poorly, spreading unsubstantiated water-cooler talk is stupid and silly and of course, assuming the worst in people is only something we do transiently, we will forget all that when we have to work together. 

And you may argue, "So what if I hook up with nine of my classmates without concern for the feelings of my colleagues? So what if I don't do anything to stop cheating, so what if I don't put an end to inflammatory rumors.  So what if I notice someone who needs help, but don't necessarily do anything?" Of course, if this was the real world, if this was not merely school, if this was my hypothetical, vignette-crafted patient, of course, I would help them.

We are in a profession that is all about taking care of people, but sometimes, it startles me how very little we often take care of one another.  This is hard work.  It is hard to smile at someone you don't know when they look miserable, it is hard to abstain from deprecating comments about a classmate (maybe one day, your boss, your best friend, your best man),  when everyone else is.  It is hard to remember sometimes, that empathy is not a class, it's not an algorithm.  It should (and I believe it is), a basic tenet of your character.  But in a land of short white coats, where it is easy to deflect the blame to our inexperience or intellectual naiveté, we should always remember that crafting and working on our emotional intelligence is an active process.

October is Community Outreach month (I know I know, everything is a "Month" of Something), but I write this because it's hard to give people the benefit of the doubt sometimes, let alone reach out to them. The parallels between high school superficiality, click-like behavior, and other forms of emptiness can be striking with the attitudes we find in medical school. We are students, sure, and have been for what seems like forever.  But after we are done hiding behind our books and our laptops and our short white coats, after we are done with Tegrity and scrounging for empty classrooms like animals finding their dens, we are adults.  Technically, we have been adults for a long time now.  But we are human, we forget.

So in addition to being the empathetic, community-service driven pillars of society you can be, I challenge you to start locally.  Start by helping the person in the seat next to you.  Start today, because it might make all the difference to them tomorrow.   

But of course, you already knew that. 

Restless in RGU

We are, for the most part, very aware of the significance of the sun.  But sometimes, I think we take the moon for granted. 

For example: tidal motion.  The moon's gravitational forces are strong enough to disrupt the delicate balance of Earth's inward gravity and outward centifugal force, making the water of our ocean's swell and bulge.  As the moon orbits Earth and we rotate like we always do, it creates high and low tides, depending on our distance from the moon and this centrifugal force and moon's pull, justified by a bunch of math I won't bore you with and any surfer who will tell you why they get up at 4:45am.

In college, some of us rogue lap swimmers formed an open water swimming club.

It was banded by a few of us who swam Masters and Intramurals, but were tired of the confines of a pool and lane lines and passive-aggressive circle swimming.  I harp on my alma mater a lot for its superficiality, affluence and protective bubble of safety (the safest city in America!), lack of crime and any sort of miscreant behavior, a sterile, slightly naive and carefully delineated city of Irvine bred out of commercialism and technological growth and median incomes over 120k, but it doesn't mean that I didn't enjoy the 2.0 mile walk down the Orange County Newport Beach coast straight from campus.  

If there was one thing I enjoyed when I felt trapped or stagnant, it was the ocean.

When you're under water, it's like you are safer than anywhere else. You are immersed in a medium nearly 1000 times more dense than air; the protective effect of a being in a place with subtle but undeniable entrance requirements.  You cannot be in water if you don't know how to swim or you drown.  You can't submerge yourself if you cannot withstand a little hypoxia.  You cannot make forward progress if you have not learned how to effectively stroke, how to get from A to B in ways other than your bipedal default.

It's not a matter of a sense of elitism because you can swim, at least not for me.  It's a sense of security knowing that, when I am stressed or lost or cannot talk or think or engage or humor others, I can run to the ocean with bare minimum: a suit, a cap, maybe goggles, and my bare feet, and I just can run in and the waves hit your shins and your body locks up because this isn't the Gulf of Mexico and its freezing even in summer, and you can keep running until you finally just hold your breath and dive forward and then you are free, and all those problems are on the shore behind you, and they cannot necessarily catch up to you in that moment. 

It's a matter of knowing that you have to possess a basic knowledge of self-sustenance and survival and skill to go somewhere that others might be too afraid to go, and that reassures me that I will be happy, successful, even if I am not shattering world records or swimming to a finish line.  

In the water, you make changes.  You take up space: you matter, and you are also matter.  But in the same way that you do not change the Volume of the Ocean, you don't just dissolve into it.  You can be inconspicuous in the vastness but not dissolving, not becoming insignificant.

We are a little more than halfway through our Reproductive-Genitourinary-Ob/Gyn (lots of hyphens) course and I cannot lie: I do not enjoy this.  I just don't.  Am I a baby-hating lady?  Eh.  I am just disinterested.  Not everyone feels this way, so don't freak out if your prerogative and life dream was to be a smiling obstetrician with forceps and lollipops.  Like any course, some people are in heaven, but in RGU, I am not one of them.

I find this ironic, because my grades have never been better than they are now.  And believe me, I am trying to care.  You would hope that one's enthusiasm would mirror their numeric grade, but I suppose if that were true, I would have a 200% in OMM or 99% in GI.  But I don't feel a personal connection to RGU, no fire is lit underneath me, no zeal for mechanics of delivery, and even the pathology seems redundant (an area I normally get excited about-a game of "what cell is that?"  "What stain is that?").

As medical students, even as physicians, you're not supposed to become disenchanted so early.  "Supposed to."  But it happens; it would be unrealistic and negligible of me to mention otherwise and say that all subjects in school will be rainbows and Zebra cases with fascinating outcomes.

But I think it's something else too.  Something that gives me that urgency to find the ocean, the way that the Ocean seeks the Moon to make a tide, the way the water seek the shore to make a wave, to dive in and escape for a moment, to chase something with purpose. I'm not necessarily overwhelmed either.  I'm not behind, I'm not sick, I'm not (too) depressed and I'm not ungrateful.  I'm training for the Philadelphia Marathon, so I should be running, but all I want to do is be under the water, to be away without having to go too far, to be untouchable for a second, to be alone but not lonely.

And to balance some of this feeling of inadequacy (not necessarily personal, but an lack of fulfillment, so to speak), I've tried to be a little more involved in the community.  This isn't a shameless plug for a high-five or public commendation, but I put this here because I think it does, or has, helped me be a little less jaded.  It makes me feel less like the Moon beckoning a tide, needing something to respond to me to produce a tangible, visual effect, and more like the ocean water seeking a higher purpose, a reason to have motion and a goal.  In essence, to make it less about me, as 25 years of living have shown me that when we start thoughts or phrases with "I wish," "I want," "I need," or end them with "for me," "to me," it is deeply and perpetually unsatisfying.

And singing, running, in Pulmonics A Capella or PCOM Running Club with Philadelphia's Back on My Feet (a running club dedicated to ending homelessness through personal growth and setting goals), have filled some of the void that used to be gratified by diving headfirst into my ocean when I was confused or sad, when I wanted to think without being perturbed.

A lot of photobombing going on at PCOM Pulmonics A Capella volunteering (aka singing) at CASA's Superhero 5k.

No picture without a Justin cameo.

Pretending like 13.1 miles is nbd.

It's still a strange and sometimes disconcerting feeling to realize that, unlike much of my early adulthood, I cannot just pack up the car and change my plan and drive 400 miles from my problems, my disappointment with something that is then and there and somehow could be escaped if only I took my car to the highway and made it to San Francisco overnight and turned off my phone.  I can't really do that anymore; I cannot fly back to California the way people drive to their home in Hershey, I cannot book a trip to Toronto just because it is perfect and immaculate in my eyes and this is not.
I cannot just ignore things, because I am 25 years old and I can be selfish sometimes, but I have to be malleable and willing to adapt, not make my scenery adapt for me hoping it wipes the slate clean.

Maybe you have felt the same way.  Maybe you have felt like, you are doing the right things according to the Algorithm of Leading a Successful and Satisfying Life but they just don't fall into place, the margins are frayed and the puzzle doesn't complete itself so perfectly.  Maybe you feel like you always are travelling but not necessarily arriving.  And that is normal, that is ok.  But it's when you feel that way that you, aspiring medical student or new little doctor or whomever you are; that's when you have to decide if you let yourself drown in your ocean, if you don't want to try to make yourself look harder, seek harder, work harder, looking for your moon.  If you're going to feel sorry for yourself or if you're going to get up at 5:00am to hang out with that homeless woman who is more Gloria than she is homeless, if you're going to help your struggling friend in the Anatomy lab and see it as a burden or change, no-challenge- the way you think about helping people selflessly because it will make you BOTH better doctors.

This post was a little more allegorical than I would have liked, but the message is the same either way.  You cannot change where you are and you cannot change the pull of the Moon or the rotation of the Earth or the flares of the sun or the grade you got on that last test.  You cannot alter the tides merely by being in the ocean; you can't hide in the sea forever because eventually, you'll have to go back to the shore where everything you tried to neglect is obviously unmoved.

And I'll end on this note, an excerpt from David Foster Wallace's "This is Water," because frankly, I cannot say it any better.  So if you have skimmed this incredibly lengthy blog, at the very least, read this part. It is the most important.

'Worship power, you will end up feeling weak and afraid, and you will need ever more power over others to numb you to your own fear. Worship your intellect, being seen as smart, you will end up feeling stupid, a fraud, always on the verge of being found out. But the insidious thing about these forms of worship is not that they're evil or sinful, it's that they're unconscious. They are default settings.

They're the kind of worship you just gradually slip into, day after day, getting more and more selective about what you see and how you measure value without ever being fully aware that that's what you're doing.

And the so-called real world will not discourage you from operating on your default settings, because the so-called real world of men and money and power hums merrily along in a pool of fear and anger and frustration and craving and worship of self. Our own present culture has harnessed these forces in ways that have yielded extraordinary wealth and comfort and personal freedom. The freedom all to be lords of our tiny skull-sized kingdoms, alone at the centre of all creation. This kind of freedom has much to recommend it. But of course there are all different kinds of freedom, and the kind that is most precious you will not hear much talk about much in the great outside world of wanting and achieving.... The really important kind of freedom involves attention and awareness and discipline, and being able truly to care about other people and to sacrifice for them over and over in myriad petty, unsexy ways every day.

That is real freedom. That is being educated, and understanding how to think. The alternative is unconsciousness, the default setting, the rat race, the constant gnawing sense of having had, and lost, some infinite thing."

Heart Block: Digoxin, Dating, Distraction

Like most of these musings, I had the intent to go to bed.

I gave it 12 minutes, or about 3 repeats of the same super cliche borderline Emo parading as alternative EchoSmith song, before I threw off the covers and climbed out, the familiar glow of this light emitting diode as I open the screen, log into Blogger, pretty sure this kind of post is one I make a conscious effort to avoid composing because

1)I will ramble when prompted by feelings of fervor and
2)I will ramble when I'm generally distracted and
3)I will ramble when I'm a little sad and
4)I will definitely ramble when I'm trying to procrastinate for an exam (our second/last/50% of your grade GI test on Tuesday)

But mainly I have, and try to, avoid compositions that dance around the subject of doling unsolicited dating advice in medical school because no one's path or circumstance is ever quite the same.  There is too much inconsistency in individual needs and wants, superficial or primal or genuinely well-intentioned.  So this won't be an entry about advice (it never really is, anyway).  Rather, I will vaguely share my sentiments, because they are the ones that have kept me up at night, the ones I pretend don't bother me, the ones that I can easily attribute to stress or the "anxiety-of-medical-school-la-la-la," and no one will ask anything further, but you, Reader, have the anonymity and freedom of nodding your head in agreement, clucking your tongue at the effeminacy of an issue that revolves around heartache, and neither one of us have to know.

But I bring it up because the distraction of all this is a very real thing; maybe you've experienced it, or will, or are fortunate enough to have not had to.

When I moved here, in a sense, it was very liberating.  2,400 miles of distance between anything remotely semblant of home, including but not limited to failed relationships, the relationships in limbo, the cusp-of-something-but-this-would-be-a-bad-idea-maybe-on-your-Christmas-break? relationships.  All of those were snipped, left at LAX if not further, some by choice and some with a little more reluctance.  But either way, it didn't matter.  I got to go and move forward with my life and anything that wasn't Philadelphian or Osteopathic or in a textbook was frivolous, and that was just fine.

We all know that integrating yourself in a new city (for some of you, maybe just a new school like PCOM-the premise remains the same) is multifactorial: your psychological happiness is pyramidal; what is most important to you may differ from your neighbor, but finding friendship and concomitant self-sufficiency constituted my base.  Those were easy.  It takes time to foster, to convince people you aren't a psychopath obsessed with Cat Videos or whatever, but ultimately, you find your group and your groove, your study spouse and your coffee place and it works.

And you find someone, whomever, that is not just your group.  Maybe you find them outside of school, and you silently thank God that they're not talking about test grades or how annoying Tegrity can be and you appreciate the diversity in conversation for once, but for whatever reason (probably time, lack thereof, probably a growing disinterest, probably a raging conflict of passing CMBM vs. Man-who-doesn't-go-to-your-med-school), you let that fish off your rod, and that too, works.

And that transient distraction, you say: "It was for the better."  And it was!  It was for the better.  Your grades go up, you re-integrate into your group, you prepare for summer, your countdown begins to focus less on a person and more on the general freedom from a curriculum that has decided when you can hang out with someone, and where.  You look forward to the options, even though you aren't necessarily obliged to exercise that freedom with anyone in particular.

And between deafening pub conversations, flops of IPA-compelled awkward text messages you wish you could erase, somewhere amidst too many manipulative mind-games from people you don't really see a longitudinal future (<--I hate that word, by the way.  Everyone will take that to mean marriage when really, future means like, two hours from now, a week from now) with, at some point between frequent hall passings and coincidental meetings and weeks of trying to convince yourself that you are DEFINITELY not attracted to that person, no, no way, you must be bored, or desperate, or what is wrong with you, maybe you're sick?
Weeks of that and you say...eh, maybe. Ok, maybe I am interested.  Or maybe I'm bored.  Or both.

And then your 'maybe' will succumb to, yes, that was deliberate.  I was not acting under duress, I can admit to myself that it's okay to be attracted to someone who is not your archetype, in aesthetic or personality or otherwise.  You can admit that it is okay to deviate from your norm. It's ok to not know where it's going.  It's ok to enjoy the moment...so long as it stays enjoyable.  Therein lies a lot of what I'm trying to tell you.

Here is that point in the post where I could take one of two roads.
1)I could make this extremely allegorical: talk in ambiguous phrases and put a bunch of asterisks next to names of those involved for the sake of privacy
2) Or, I could make this a blog that berates the modern day casual relationship: the title-less, ill-defined parameters of kids (I guess we're adults?) who hook up and the gray area in between all those feelings of owing someone consistency but being too afraid to ascribe them a real place in your life, on your shelf.

I actually don't feel like doing either of those things. I don't have to name names, heck, I don't even have to allude to them.
I think, personally, it's more important to explain to you that my own sense of distraction, the one that makes it hard to think sometimes about Hepatitis or Shigella or my Case Conference, the one that makes it hard to stay asleep, is more to do with something I realized about myself, more than the person(s) that inspired those feelings.

There is a feeling of inadequacy associated with failure in romance, however you want to define that, I don't really care.  But there can be plenty of feelings of inadequacy with a currently standing romance too; one that needs not be terminated before you start feeling less like yourself. Before you feel like someone noticed something in you that you are convinced is erroneous, assured that you are being misread.

I have always been of the mind that friendships/relationships/like/love/general affability should be two things:

It should be easy.
It should be voluntary.
But most importantly, it should be easy. Because it should be wanted, not coerced, not manipulated, not obligatory, not forced.

One of my favorite bloggers (ew, yea, I just said that), Mark Manson, has an 8 minute read that I promise has relevance here.  He writes:

"Why would you ever be excited to be with someone who is not excited to be with you? If they’re not happy with you now, what makes you think they’ll be happy to be with you later? Why do you make an effort to convince someone to date you when they make no effort to convince you?
What does that say about you? That you believe you need to convince people to be with you?
You wouldn’t buy a dog that bites you all the time. And you wouldn’t be friends with someone who regularly ditches you. You wouldn’t work a job that doesn’t pay you. Then why the hell are you trying to make a girlfriend out of a woman who doesn’t want to date you? Where’s your self-respect?"

And while this doesn't necessarily mirror every aspect of the matter on my mind, it has some bearing on why I even bothered to start rambling in the first place.

Sometimes, it feels like I do a lot of work to convince people how simple the non-existent rules of engagement are.  We are all in our second decade-ish, some of us +/- a few years, but so many of us make dating, or getting to know one another so extremely analytical. Men and women can spend so much time over-thinking every nuance of eachother's behavior than we actually end up organically behaving.

Dating should be easy, it should revolve around the principle of enjoying the physical/emotional/filial company of one another.  Sure, this is easier said than done in medical school.  You are in competition with time, with sleep, with food, with class, with whatever.  And maybe this is too bright eyed bushy tailed of me, but I think it isn't that hard.  It doesn't have to be, anyways.

It shouldn't have to operate under a schedule, it shouldn't have to be planned or riddled with feelings of debt of gratitude or forced reciprocity. It shouldn't have an expectation, a set of Commandments suddenly integrated just because you one-upped from Level Friendship to Level More-than-Friendship.

It should (and it can), be uncomplicated, devoid of new expectations that weren't already apparent to begin with.  It shouldn't incite radical change, per se.  It shouldn't force you to prove that all you want is  to be benevolent, that you don't have an ulterior motive.  It shouldn't do many of these things, because at the end of the day, it should only do one thing:

It should make you happy.

We should do things, engage in acts of kindness or in the interest of others because we want to, not because we feel we ought to.  Perhaps I am alone in this notion, perhaps it is because I come from a non-nuclear family but more likely,  it is because I apply my basic rules of friendship to my basic "rules" (also, the grossest word ever.  There aren't any rules; this isn't prison) of romance.  You should want to make someone happy (in any capacity you want: high fives in the hallway, horizontal dancing, drinking buddy, or even leaving them alone when they're having an antisocial day).  You shouldn't impose yourselves on them, but you should permit yourself to add to the pleasantness of their day.

And all of those things I fervently believe.  But when you have to explain it, endlessly, tirelessly, it makes you feel as perhaps you are the only person who operates under this idea.  That maybe this very simple exercise of your ideology of improving the lives of others, but namely, this one person, is one rooted in naivete.  And then you go home and think; do I have an agenda? And you realize, no, you still don't, but the doubt instilled in you, the uncertainty you are dealt is enough to make you feel like maybe being nice without a cause, without an end-goal is not what you're supposed to do, because the one person you direct it towards expects that you must want something, that it can't be that simple.  And that is what gets me out of bed, gets me typing.

It is the thing that makes me close my eyes and be mad, mad at myself for being mad at Tommy for not listening to my prayers, annoyed that I have prayed over and over and over for a dream where he could make a cameo, because I'll never get one in real life again, and mad I miss my friend who I could talk to about matters of the heart.  And I get upset at myself for naively wishing I could talk to my deceased friend, when I have plenty of living ones, but I don't want to burden them with the trivialities of all this.  And then before I know it, my cheeks are hot and I am annoyed that this is still an issue, 3 years later and I still feel sick to my stomach realizing someone I had a genuine friendship, a love for, but not necessarily with, cannot be here to talk to me about a very stupid moment of feeling stupid about something that is probably not even a big deal.

And already, I feel like I have made it too personal, but then again, that is the point of this blog.  Because there is so much more to your medical education that just the mind numbing, auto-pilot nature of attending class, of going home, or returning to study, or putting in your time with your nose buried in your books.
It has so many dimensions, some of them are inspiring and filled with reward, and a sense of accomplishment, and the other ones can be like this, where you feel empty, a little sad that things are not going as easily as you hoped, despite your effort to make everything as seamless as possible, for both you and Person #2.

But that's ok.  
And that same dang EchoSmith song has been playing since 11:15PM, it's 12:42 AM and I have to get up soon, and I'm pretty sure I know literally every lyric of this embedded in my subconscious.

Til tomorrow,
Be happy, be healthy, and please
Be simple.