Surgery

I'm currently studying for the surgery shelf, which is obviously hard. For some reason, I've been feeling less and less like writing about med school. I don't really want to air my stories about patients to the world. I can see the purpose of keeping a journal about these things, but the digestion required to make it fit for public consumption takes much more time and energy than I currently have to spend on this blog. I think I will record these beautiful and meaningful events and try to write about them when I can, but it's more important for the purposes of being a good future physician to remember them and the lessons I learned from them.

But I'm alive, and trying to balance things, and still enjoying myself in spite of it all. On bad days, it really is the patients who keep me going. The "worst" (ie most stressed, angry, saddening, or whatever) patient out there is soothing compared to dealing with the school part of it. I'm really glad I am taking a research sabbatical. It will give me time to "gather my thoughts and regain my strength." Yes, 3rd year of med school and Clueless is still very relevant. Ah, Amy Heckerling. You have no idea how much you influenced my generation.

I also need to figure out what exactly within medicine I want to do, which a prominent urologist who gave us a lecture yesterday called "absolutely the most important decision you will ever make in your careers. And soon they won't be allowing you to take a paid 2nd residency, so it may be a one-way street." This does seem like a lot of pressure. Which is why I have taken up yoga again. But that is another post for another time.

Self-Discipline

A stitch in time saves nine. Never put off for tomorrow what you can do today. Idle hands are the Devil's workshop.

I have been thinking about self-discipline. All my life, I have struggled with procrastination and absent-mindedness. Some people are born with an innate ability to plan ahead, execute that plan, and not forget anything along the way. Unfortunately, not so with me. I have a tendency toward both, which was pretty much indulged throughout my childhood. For instance, I remember when my mother was furious in 7th grade (7th!) when I didn't organize my homework the way the teacher wanted, and had marks deducted from my grade, even though the math was correct. She was furious because the math was correct and so I shouldn't have had marks off, not because I got in trouble with the teacher.

Looking back, what she, and I, failed to realize, was that the discipline of doing your homework neatly and on time is a skill that is in some ways far more important than math. And while elementary school math is easy, college math is impossible if you can't write neatly, keep your notes straight, or remember what's due when. If I forgot my books or projects at home or at school, there was always a doting parent or family member who would help me go fetch it. If I was up against the wall and hadn't done the work necessary for the day, there was always a parent willing to help me with an excuse. I thought it was funny and wonderful at the time, and once or twice it would have been. But the constant message to me was as long as you're smart, you don't need to be self-disciplined.

Don't get me wrong, I learned many important skills growing up: to dream big, to think positive and look for the silver lining, and to never give up. But this is one area in which I still need to help myself out a little bit. By definition, you cannot be nagged or coaxed into self-discipline. You must simply learn by running up against the cold, hard consequences of your decisions. As you get older, the price of doing whatever you want gets higher.

The word "discipline" has come to mean 'punishment'. But in another sense, it means 'practice'. Taken in this way, "self-discipline" actually implies "self-practice" -- the practice of exercising one's will, or self, over the mind. In many different philosophies, people have written that the mind is apart from the self. The mind is something to be trained, like any other muscle in the body :) Power over your mind allows you to make choices that are best for your true self.

For instance, let's take today:

My mind: It's so pleasant just sitting here, typing and drinking tea. Let's not start our work at all! Or we can stay home and just do a little bit at a time. There's still a lot of time until the test.

Self: You have a big exam coming up. Today is a free day, which is a wonderful opportunity to immerse yourself in the material before it becomes urgent and panicky. If you start today, January 23rd, that only gives you three more full study days before the exam, plus whatever time you can fit in during the week. You'll be able to concentrate far better in the library than at home.

Both college and medical school would have been a lot easier for me had I developed this discipline, or practice, before I left home. But I have a feeling that it's like exercise -- the more you do it, the easier it gets, and the more fun it is. If you have conquered a similar problem and have some good advice for me, please write!!

In the meantime, off I go. Wish me luck.

Am. So. Sick. Of. Working.

No matter how much I do, it seems like a tiny drop in the bucket. There are never ending tasks, some of them important, some of them urgent, all of them necessary. It wouldn't be as mind-numbing if the urgent ones and the important ones were the same, but it's like they want to make ABSOLUTELY sure that we do a clinical journal that no-one will ever read, but if we get around to writing up a patient note, whatever. Huh!?

I am so underqualified for my life.

Whew.

Things are a little less completely insane now. I have taken the exam, although because it's a national shelf I'm not sure if I passed it yet -- that will take a few weeks. The cat's other end seems to be functional, and she didn't even need an enema. Just a phone consult. We had a clinical skills video evaluation, which I think went well. Unfortunately, of course when things go well they're pass/fail. And then I was on cardiology for four days. My patient was a lady who came in to rule out a heart attack, which she didn't have. Then it was thought maybe she had heart failure (yup) but not due to a common cause (hmmm). So now she has been discharged and is going to see her doctor for many unusual tests which will hopefully solve the riddle of how she is walking around asymptomatic when her heart can only pump 30% of its final volume to her body. Good for her, at 80!

One of my OB patients, whom I had been working with pretty closely, was finally delivered of her girlchild. By me!! I did the entire delivery all by myself, which was the first time ever that I have run a delivery. It was amazing. And because it was the first night of my cardiology call, which was right after the OB shelf, I basically haven't slept well in over a week.

Today we were teaching the MS1s about heart failure. It turns out you do learn something in two years, after all. But they were better at heart medications, having just studied them. Oops. I guess I need to review all of the latest options myself, since on the wards I'm not the one deciding which meds are the best. I also learned today that soon they will come out with a better clot preventer than warfarin (Coumadin), and that whoever wins that particular pharmaceutical race is going to be very rich.

I got my first psychiatry patient today. He's awesome and has depression. Hopefully we can get the poor guy being more awesome and less depressed and back to his old self again. I have had other patients in psychiatry clinic, but this is the first one whose care I'm supposed to be in charge of. Fantastic. I feel behind in psych and need to study it more.

I got all fours (good) on a recent surgery evaluation. I think they evaluated the wrong person. I'm not going to tell them when I have surgery tomorrow.

Finally, I am excited because I think I might get enough sleep tonight. I'm really, really excited. I'm looking forward to it. I've been dreaming about my nice soft cottony plump firm pillow all week long....ahhhh....

It Has Passed.

The poo.

Now I just have to pass my exam.

Not an entirely different meaning.

A Charming Topic...

So my cat hasn't had a poo, as far as I can tell, since Tuesday night. Now it's Thursday morning. She is otherwise acting well and eating and peeing, so I am now left with this interesting dilemma. Given that our OB/GYN shelf exam is tomorrow morning, at which point do I need to take her to the vet? Pre-exam, or post-exam? Poor little old lady cat. I will let you know how she does (she thinks she's fine). I'm pretty sure there will be an enema in here somewhere before this is resolved.

Sigh. What purrfect timing.

More Examinating

The next one is OB/GYN. And for anyone out there who thinks that it's all 'natural' and 'simple' and 'what can possibly go wrong with the female reproductive tract and kid production?' The answer is: Way. Too. Much. Please, if you or females you know have symptoms, get over your embarrassment and get your a** to a clinic where they know what they are doing ASAP. Your nether regions are very important.

Ok, back to studying. Guess who has cardiology call right after the OB/GYN exam?! Four days and nights of taking care of people whose hearts are acting up. Both very cool and incredibly scary. Just like med school.

My personal motto: Just keep swimming, swimming, swimming...