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.

The Psychology of Insecurity

I'm in California. Just kidding.  Now I'm in Pennsylvania.  But I started writing this last Friday so there's that.  Pretend it's Friday.

Tomorrow, I'll still be in California.
But MONDAY.
Freakin' Monday, man.  We will all be back in school.  All 270 (er, 250-something now) of us, displaced first years of 2017 shoved into the role of semi-less-confused second years, passing the gumshoe-doe-eyed-deer-in-headlights baton to the class of 2018, wandering around with our little lunch pails with Tupperware and our backpacks on just one shoulder and new shiny Staedler Fine Point markers in 80 colors like it's the first day of school for the 19th time in our lives.  Have you ever thought about that?

We've done this rodeo show now FOR NINETEEN YEARS (give or take).  If you're of the post-baccalaureate variety like myself, twenty.   TWENTY YEARS I have packed my little boxed lunch..maybe your mom has...eh, maybe your mom still does, I don't know, and packed my backpack with new 3-ring binders getting progressively more ginormous and done my homework and marched/sprinted/driven to school.

Twenty years I have been a student.  K through 5th, then junior high, then high school, then college, then add a year because I sucked at physics and all things science and had to remediate a ton of classes and trade in a Drama Major for a little certificate of "You Are Smart Enough in Vague Science Prerequisites!" then first year of medical school and now second year. 

On August 1st, 2013, I packed up pretty much everything I owned and coalesced it into two large suitcases and drove with my best friend Zack to the Long Beach International Airport in California.
I remember throwing out a decent pair of running shoes because otherwise I was going to pay an overweight baggage fee and in my irrational and anxious brain, it made sense to avoid 50 dollars by tossing a pair of 40 dollar shoes.  Right, I'm dumb when I'm nervous.  Anyways, I remember we ordered wine at this wine bar in the airport because this was the start of our lives.

Zack, my Best Man Friend.  Taken the day we got the hell outta dodge and went to medical school!  Long Beach, CA.

It didn't serve so much a celebration as it was a sigh of relief.  The threat of having to sleep in Hyundais to save rent money or the fear of stagnancy in a non-English speaking city bordering Mexico or the insecurity of "I want to be a doctor.  I'm not a doctor.  I need to be a doctor." of every waking moment and permeating every dream and every email that dinged on your phone.  For us, it was an alleviation of the omni-present anxiety that embodied everything I initially feared about a path towards medicine-lifestyle ambiguity, plans that operate on a schedule negligent of time or day or weekends or people that I want to be around, being at the whim of the demands of standardized exams (of boards, of grades, of tests that compare me to my peers).

It was a relief that I could get away from the life I was living.  Granted, I don't have much room to complain.  I have a so-so ultra-private boring middle class Roman Catholic family that sometimes convenes for holidays, sometimes we don't.  I had a job and (usually) enough food.  I had an overpriced apartment sorta near the beach and I paid too much for gas, but damnit, I could buy that gas if I wanted to.
But every day I drove somewhere (usually work because I suck and was single), I punched my time card at HealthNet, I stared out the window and I remembered just outright sobbing when I failed Physics for the second time in the row, and selling my clothes on Ebay in college in order to register for Remedial Calculus because UC Irvine just charges so dang much.  I remember this as I lived my perfectly normal mediocre life and all I wanted was to live with impetus, to live with purpose. To be present somewhere with the implication that what I was doing would one day be more important that just myself; more than being self absorbed into my own needs for "when is lunch hour?"  "When are accounts payable reconciled?"

I recently asked a first year, "What are you most afraid of entering school?"
The response was one that was familiar, one that I can bet money on is ubiquitous too all medical students, irrespective of year, to some degree.  His response was, "to have underachieved."  And when I asked for expansion on that, he explained that he was aware much of this was an intrinsic and vague sense of an expectation of excellence-an idea that were he not to achieve success in any capacity, that he would be letting someone down.  This self-imposed sense of obligation to others, to be the best because in his/your/my mind, there is disappointment at stake.

And I cannot tell you how many times you might feel that way.  Maybe your sense of insecurity will be far more transient than mine; perhaps you have a better sense of self-worth and capability.  But even now, having "survived" first year, if you will, having passed (usually barely) all markers of academic aptitude, having somehow managed to not totally hate everyone and everything and hide 24/7 in the Anatomy Lab (although I do that now and again), I still feel in jeopardy of just undoing everything.
It happens often. It happens when I eat lunch and everyone seems so fraternal and happy.  I'm not a depressive person; if anything I overcompensate with this zeal and zest of "HI HOW ARE YOU la de da de da?!"  But I worry that I will always be on the cusp of failure; that the person they tell stories of being "so close" but just couldn't hack it will be me.
I'll get over it.  Probably when I'm 20 years into actual  clinical practice, I'll get over it.  But should you see me stoic, or quiet, it's not because I know what's going on.  Usually, it's because I'm too afraid to divulge that I don't, and so it's easier to remain silent ninja struggling student until I feel I'm at par.

But Monday, Monday is the last day of the first day of school.  Ever.  It's over man!  Moving forward is just a bunch of lectures that will blend together until Christmas, when Boards panic probably sets in.  Then that gets enmeshed in some second year senioritis purgatory when you just want the year to be done so you can go prove that you can maybe be 1/2 of a Doctor and then you're thrown into the ThunderDome of Rotations.

There are a myriad of things to freak out about.  I guarantee I've tried them all.  But there's not a whole lot you can do about it.  First years, I'm talking to you.  Benzo's, sure.  But more importantly, the management will come with experience.  I could sit here and indoctrinate you on the BEST STUDY METHODS OF ALL TIME, the books to buy, those to avoid, but really, I'm ancient in my ways.  Confused about the information in a lecture?  There's the magical thing called the internet; use it! There's your peers; utilize them!  And lastly (but importantly), utilize your professors.  They have office hours for a reason.  Think logically and thoroughly....if you can't come up with the conclusion on your own, go to the person designated to help you (read: 'help,' not 'spoonfeed.')  I assure you, putting in the initial effort prior to eliciting the easy answer will make you a better medical student, a more independent thinker.  You will walk away proud of what you know, confident in your ability.  Start becoming your own greatest resource by forming a reservoir of knowledge.

Art makes me feel less like a psychopath.  Find what makes you feel less like a crazy person and I promise you, the school stuff will come more easily.  No xanax required.

An anecdote: There was a time where I just didn't.  Get.  Histology. I just didn't get a gosh darn thing.  Wanna know why?  I'd never seen normal cells before.  Nope, a major in Drama will not give you ample histology exposure with a microscope.  So to see structures from anything but a gross perspective was just the worst thing.  And I recall trying to tell myself "Veronica, this is a Brunners gland.  Brunner's glands look like this." And all I saw was purple and pink and coils and some white space.  And I just couldn't do it.

And I'm up in 3rd floor, parked by a window with my laptop.  There's this histology quiz in 45 minutes.  And I am beyond panicked.  It's almost apathy...but worse somehow.  Like, I've heard everyone complain about how they "really wanted that 5/5" and I'm just a mess inside because for ONCE, I'd like a 3/5.  Maybe a 4/5 on my best day ever.  But no, it's not happening, because I'm having a hard enough time discerning a nucleus from cytoplasm.

And I hear the familiar shuffle of one foot just slightly slower than the other, and I turn around, and it's Dr. McGuinness.  The McGuinness that somehow narrates with his eyes closed, like he memorized the cadaver in his sleep and delivers his tutorials like the Gettysburg Address.  And he asks, "What's wrong?"

And I'm there with my bag of Trail Mix and laptop and lack of any histological foundation and I just LET IT GO.  I couldn't stop it if I wanted to.  Hot tears are just pouring out of there like woman going through menopause that ran out of Milano cookies.  And of course, because I can't handle the truth of admitting I don't know anything, I say "There's too many raisins in this Trail Mix."

Needless to see, there is resolution to this ultra-pathetic story.  What I learned was 1)If you don't get it, it's cool.  Chill out.  Don't blame it on the raisins.
2)Ask for help!  But make sure you've tried.  Nobody likes when you sit there sobbing into your bag of assorted nuts and look as hopeless as you feel.
3)Understand it's normal.  To varying degrees, you'll get stressed.  Go running. Eat a whole pizza.  Eat a whole pizza and THEN go running.  Whatever makes you feel better, just do it.  Far better than being distracted by feelings of your own inadequacy.

Until then.  I'll let you know I'm still afloat.  Stay afloat.
Remember: don't blame the raisins.  They won't help you, but your colleagues and faculty will.
Maybe even me.  Maybe.  Just don't ask  about Brunner's glands.

Sand over Gland. (Corona Del Mar, California).

Advent of Year 2

Hiatus is over.

I'm notorious for excessively lengthy prefaces.  Perhaps this is because much of what I choose to divulge as your bright and shiny DO Blogger is so poorly defined by the parameters of three paragraphs and a clever header.  And so, like time and time again, I'll word vomit until you elect to stop reading.

But hopefully, you don't.  Hopefully, you are the right person, at the right time, reading those choice words.  Hopefully, something strikes a chord with you, whether you are like me, closing the curtain to first year summer limbo and entering second year; whether you are beginning your journey into the entering DO class of 2018 from whatever life event or academic segue that brought you about this way, or whether you are a curious onlooker, wondering if "it really it all they say it is."

In personal matters, I have news for you.  Miss Williams is getting married.
Jokes on you though: Miss Williams is my mom.  (We share the same surname).  Ironically, everyone is getting married.  Like...everyone. My best female friend just jumped on this bandwagon about two weeks ago. Don't roll your eyes just yet, this isn't to be followed by some sour-laden statement like "I'm just sitting here becoming a doctor, you all go on with your life milestones." I haven't met my mother's fiance yet; in a way, I have trepidation about the whole thing.  It has much less to do with the introduction of a new man (the only man?) in our small little circle of Williams' widows and singletons than it does with the fact that it is a very existentially alarming thing to see (recall) that medical school and all of its gravity and levity and trivialities and legitimate concerns and drama or mundanity are not the center of your life (all the time, anyway) or that of others  In the end, it's you within it, again, in this bubble that removes you from the ongoings of normal people, and when it's over, you have the blessing of an institution to rejoin it (albeit sleep deprived, you are qualified.  You are something. You are someone). Everything else, marriage included, must be malleable to the shape of your academic career.

But it is funny, in a way, to remember that people can mark progress, and personal growth outside of school with events and celebrations that don't pertain to "I passed this exam" or "I placed out of histology."  It is silly that I sit here, on the phone with my mother, a fellow single woman for as long as I've been alive, and briefly talk details of what is typically one of the biggest days in someone's life as a mere calendar event-in some ways, an inconvenience.  Because the topic progresses from "How exciting!" to "When?" to "Who?" to "But not around boards, right?" to "But yes, around boards" to "In that event, it is not feasible; I cannot go."

And that doesn't bother me so much, an inability to attend my only parent's first wedding.  It frightens me a little more that this mutual decision is one made so nonchalant, like that I can't order pizza in because the coupon expired.  Like this is just another exam.
For that, I will always have a distaste for the jail that is professional school.

But last night, I attended the gala (I'm just going to call it a gala...all things dinner and dance will hereby be known as Gala) for the Masters in Biomedical Sciences graduates.  Many of whom, in attendance, will be joining the Doctor of Osteopathic Class of 2018.  And I couldn't help but be so...excited.

Excited for them.  Excited for you, should you be one of them.  Excited that, regardless of what your acceptance means to you (maybe you have adopted the attitude of "it's about time" or "Thank God, I can spend the last bit of my 400 dollars in the bank" to "I have a life.  I am defined."), you are becoming Someone.  You have always been someone.  But now, someone (some school, really) has publicly declared they trust you with the knowledge and professionalism and genuine humanity that constitutes the intelligence and benevolence truly needed to be a physician.  I have always been of the mind that you cannot have medicine without an interest in people-all people.  Does this limit everyone to Family Medicine?  No.  But it does set a very nice stage for your approach to patient care in any capacity or specialty-not solely your aptitude but your concomitant desire to see and work for the improvement of their quality of living of others at what occasionally comes at the expense of your own. 

I am excited for you.  If you are like me (which I understand would make you eccentric, odd, a hot mess on occasion, verbally overbearing, etc), your acceptance to medical school means you never have to sleep in your car again.
It means you never have to park behind an Albertson's lot during summer school.
It means you never have to make a decision between money and food or education.
It means you can have all of those things.
It means that, you are given the opportunity, one that 8000 people this year sought out just like you, to sit in a seat 270 were priveleged with, to prove (not because you ought to, but because you want to) that you are working for the betterment of your immediate society and the advancement of a medical and scientific one.
It means that, you are assured a spot in Ginsburg, which is of the utmost insignificance, but more importantly-MOST importantly-you are assured a degree, pending your unrelenting hard work and dedication, lots of pots of coffee and occasional cynicism and sometimes missed marriages and tests instead of birthday-a degree that lets you physically CHANGE others.

You can CHANGE them. Most times, it will ideally be for the better.  It may be preventative, and life saving.
It may be defensive with intervention, and no one's lives are for the better.
But you CAN change them.  You are one of the few professions in the world where you can utilize your mind and your hands together, and you can feel for disease, you can think for curative measures, you can instruct and teach and palpate and feel and improve.  You can do this, and someone believed in you enough to grant you the greatest opportunity- a medical education.

And you will forget this at times.  You will be tired, and annoyed. You will be upset, and cranky.  You will say things you don't mean to your colleages and your friends at home, to your spouse or your children.  It will be mentally and physically demanding in ways (unless you've been to medical school before) that you have not experienced before.  It may not be "harder" than labor, or more "difficult" than an Iron Man, but it will be tough.  And it will be tough when you enter your second year, when you remember all those nights that melted into mornings, all those exams you could have cried over because, yea, damn right they dictate your future. That one scantron says "Yes, collect 500 dollars and pass Go, be a DO."  Conversely, it can say: Stop.

Work hard.  You will.  When you think you've worked hard, work a little harder.  Work as hard as those 8000 applicants worked to get where you are fortunate enough to be today.  I am excited for you; never forget how excited you were the day you read a header that began with

"We are pleased to inform you."


xo,
V

OMS-I: Year in Review

So here we are. 
I'll get the boring housekeeping agenda out of the way first.

1)Cardio Renal Pulm/ Primary Care Skills/ CRIBS/ OMM: You'll be pleased (Heck, I AM PLEASED) to know I survived finals.  By survived I mean I passed them.  And yes, even this super extra medium mediocre barely-hanging-on-by-her-70s student got an A.  One little wimpy A in a sea of C's and B's, but an A nonetheless.  Proof that no matter how many nails you chew off with anxiety, how many gunnerisms you hear in class that make you want to punch your colleague, how many intimidation jedi-mind tricks are executed before an exam, or how simpleton you feel in contrast to those around you that seem to pump out 80s/90s like eggs from chickens on steroids...you, yes even you, most certainly you, can catch a break once in a while and look like you know what you're doing.

2)Anatomy Teaching Assistant:  I'm doing it. Catch me on the 6th floor skinning people once in a while and pointing to nerves hoping they aren't arteries.  Also if you have questions about the cadaver that lyeth before you (this is mainly a PSA for our incoming PA Students), don't hesitate to inquisition the crap out of me. I'll bestow what little and ironic wisdom I have.

3)Existential Crisis: I have nothing to do.  I babysat my Professor's chickens and German shorthaired pointer for 3 days.  I slept in.  I MADE STEAK.  Actually that's an outright lie, I ate the steak that someone else made for us.  I picked berries from the garden like I was a gatherer of the Paleolithic era.  I went to the gym without notes. I visited my first drive-through beer distributor.  I WATCHED HULU JUST BECAUSE I COULD.  Then I read Cosmo so that I could lose some brain cells and not even feel bad about it.

Then I realized (for real-real realized) I am out of school.  With no agenda.  (work sort of counts).  But I don't have to use my brain beyond the scope of pointing and identifying for people learning Anatomy.  I DON'T NEED MY BRAIN!   I'M SO SO SO SO SO SO HAPPY!

This post predominately provides proof (alliteration-train!) that I am alive, not drowning any academic miseries in a sea of calories or the Delaware River (I do that regardless, usually celebratory.  Lies-I do that daily.  At breakfast. Dinner.)
It also sets an interesting precedent for summer "adventures" that may or may not be of interest to you.  I've never not had anything to do before.  I've never just lived of the land. So you'll have to excuse how potentially eccentric there posts could evolve into over the next couple months.  Also, should you have questions about school, logistics, moving here, blah blah blah, don't hesitate to contact me.  Obviously, I have markedly too much free time.

4)CANADA: Yea yea yea, it's not as exciting as Brazil or Honduras or Ecuador or whatever.  But I couldn't venture too far from Anatomy TA business and I have a 3 day vacation with limited funds.

So I'll be heading to Toronto tomorrow!  Don't ask me what I'm going to do because...I have no idea!  I booked a hostel on a whim and I take a 10 hour bus-ride tomorrow overnight. This is part of my annual Veronica-Sabbatical, where I typically go rogue for a couple days (or weeks) and go stare off into space and intimidate another culture/country of sorts.  It's also nice just to be away from Philadelphia for a minute, even if it's not as exotic as I'd like. 

If I wake up in a bathtub immersed in ice cubes with some vital organs missing, you know what happened.  Please alert the US Embassy. Although I can't imagine Canadians trying to steal and sell pieces of my body without at least being a little polite about it.  "Do you want something to drink while I take our your kidneys, eh?"  "Nice weather today, eh?  Do you think it would be a problem if I were to maybe yank out yer' liver?"

5)So many pictures.  I decided to be marginally social after our exam for our final PEP.
Mainly I just wanted to make a bunch of "I'm on a Boat" puns with related captions on facebook.  Consider it a success.  I've included them below as evidence that I see the light of day once in a while and that my friends are not imaginary.

Au revoir!  See you in a few days with hopefully all of my intestines intact! 
xoxo, V

Hung is dead.

CRIBS Love Part I.

CRIBS love part II.

my best friends are awkward.  we go well together.

you can high-five Alec for putting us On a Boat.

Never Let Go....Whoever you are.

Pulmonics Love Part I.

Pulmonics Love Part II.

Mark becoming extra-creepy.

The Dom Father.

Half-smile Kyle.

I just...I don't. 

This is my summer.  Every day.  All the time.