"Residency is like delayed adolescence"

The other day my attending, who's main focus in life and teaching, said to us "training is like a delayed adolescence. You want to be off on your own but still want the protection of the 'adults.'" He gave a couple of examples of how, developmentally, we trainees are basically a bunch of teenagers trying to navigate the system, grow and develop, try and gain new responsibilities, and assert ourselves while still gaining valuable information from our attendings. I felt like this really resonated with me. Particularly because earlier that day, with that same attending, I felt an overwhelming need to rebel against him. He asked me a question during rounds, one that was very easy to answer, but I just didn't want to. I had no good reason for not wanting to answer. I just knew it would confound him that I wouldn't do it. And like the teenagers I work with, when asked why I was behaving that way, all I could say was "I don't know." Residency has been great. It's hard, and I struggle sometimes with the workload. It's not perfect. But compared to medical school, it's like a dream come true. There is a developmental life cycle to medical training. Residency is like being a teenager again. You're expected to do things on your own, but you are always under the watchful eye of your superior. At the beginning of residency this is very comforting. You are thankful for adult supervision to navigate this new and scary world. You get responsibility but you never have full responsibility. It's a safe time to test the waters, try new things, and start thinking for yourself. You always know that if you make a mistake someone will be there to help you through it. As you get further into your training, you start getting more responsibilities. You are given less supervision, but still know that someone is watching out for you. Slowly though, you get annoyed that there is someone you have to answer to. They get to make all the rules, and you are just expected to follow them. You want to make your own decisions but you can't. Someone else always has the final say. Sometimes you understand their reasoning for the decisions they make. Othertimes, it seems more like a "because I said so" that you are just expected to follow. You will find yourself rebelling for no good reason. You think you know everything. You think you are indestructible. You learn to manipulate your attendings into doing what you want. And when you mess up, they clean it up for you. Near the very end of training you find yourself with conflicting emotions. On the one hand you feel ready to go off and be an adult, and resent having to still be "under their roof" of training, but you also are fearful of being an adult and not having someone to rely on. I assume the first few years outside of being an attending are like young adulthood or college. Attendings really are like parents. They watch over you. They help you out of jams. They nurture you and take care of you. Sometimes they have to discipline you. They think they know it all. How many times have I heard the "when I was in training..." from an attending. I once told an attending "yes and I'm sure you also had to walk uphill in the snow both ways without shoes when you were in training, but that's not how things are anymore." Luckily I went to a training program where the attendings have a sense of humor and put up with my sarcastic, whiny teenager remarks. Different attendings have different parenting styles. Some let you sink or swim. Others hold tight to the reins. And others have that perfect balance of teaching while also letting you learn for yourself. One attending intern year said "I basically let you do whatever you want up here. As long as you have a reason and the patient isn't going to get hurt because of it, I want you to learn by trying different things." Others were like "under no circumstance will we try new medications that I haven't had experience with yet." Another similarity between being a resident and being a teenager is your concept of time. Teenagers have only lived for less than 18 years. So to them, each year is an eternity. Telling teenagers that high school is only a couple of years always falls on deaf ears. Because to them four years is almost a fifth of their existence. Training feels the same way. When you're in your late twenties or early thirties, another couple of years can seem like forever. People decide against fellowships because they already feel like they have wasted too many years in schooling. But to attendings, a couple of years is nothing much. They seem to forget how much each year of training felt like an eternity. Their parent-like advice falls on deaf ears, as you think in your head "you were never this young once, you don't know what it is like. YOU JUST DON'T GET IT." In my second to last year of training, I feel more and more like my teenage patients. I want to grow up but don't want to. I sometimes think everything will be perfect once I'm out of training. I tend to rebel needlessly against my attendings. But I'm also terrified of growing up and having to make it on my own. The struggle is real.

I'm glad that guy isn't in my class

This summer I got the chance to go to an international medical conference. A bunch of us health professionals all having a good time together. I go with my family and I'm not great at socializing with strangers, especially those my age, so I didn't really talk to much to the other young people, preferring the company of my mom and cousin. I didn't really even notice many of the other people, just that there was a group of people who were maybe around my age that all hung out and that I didn't really feel any need to get to know. But there was one guy in particular that I took an immediate dislike to. Nothing really to do with him, my own biases were going crazy. Basically he was a good looking confident guy in his mid twenties, the kind of guy I love to hate, and by that I mean fall in love with and then manifest it as hatred towards them when they don't notice me. Which is a lot of information about myself, and I actually have a point to this story. About half way through the trip I found out he had just been accepted into medical school. I overheard him saying he was nervous, but in a confident, purposefully self deprecating way. He wants to be an orthopedic surgeon, and he fits the stereotype to a tee. Maybe that'll give you some insight as to why I wouldn't be his biggest fan. I listened to him say all the words I had felt going into medical school, about feeling inferior to those who had gone before me, worrying I wouldn't be any good, fearful it would be too hard and I wouldn't make it out. But his manner was so arrogant while he said it, and it left me reeling. I sat and chatted with another medical student who was heading into his second year. And I liked him ok, I was able to tell him my story and let him know he would make it through ok. I provided some comfort and confidence in him that he would get through it all like everyone else. I had no qualms with him. But ortho guy, I wasn't sure what to do with. Part of me felt it was important for me to go talk to him. I wanted to say "hey, I heard your concerns about medical school and I just wanted to let you know that it's going to be ok." I wanted to give him the address to the blog, or my contact information if he needed anything. But I didn't, and I'm still not sure why. I told myself that it was because my mom was always telling me to stop scaring people before they go into school. She said I'm too negative and I don't need to tell everyone it's going to suck before they even start. I'd heard that from the Dean at my school as well. I told myself I was sparing him unnecessary worry. Maybe he'd start school and excel and really love it. Why dampen his happiness at starting with my negativity at the process? But I don't think those are the real reasons. He's the kind of guy I wouldn't want to be in class with. The kind of guy who knows how to manage himself. He'd never let me see that he was struggling. He would be the kind of guy who makes me feel bad for feeling bad, always talking about how great he is doing and how much smarter he is than everyone else. He's my worst nightmare. That is what I saw when I stood around him or tried to talk to him. Oozing self confidence. So I didn't feel the need to offer him support because I didn't think he'd take it. And I knew he'd look down on me for offering it. In medical school I stood up in the class of first year students and told them how I'd struggled through the first two years and failed the boards but was surviving and if any of them needed me they could just call me any time. And mostly I got good reviews and some thank yous from that. But one guy came up to me a couple days later and said "you do know that you'll forever be known as that girl who failed the boards right?" And I just couldn't believe that he would say that to me. This ortho guy I met, that's how I felt about him. I felt like he would scoff at me and say "really? You failed the boards? That sucks. Sorry medical school was so hard, but I'm about to go rock it." He was the kind of guy that things came really easily to. He wasn't going to struggle in medical school, he was going to love every minute of it, still have a fun life, keep his sanity, and go on into the residency of his dreams. And I'm glad he isn't in my class, since I had my share of those and I don't need another. But he is going to be in class with one of you out there. Some poor struggling student is going to be in a small group with this guy, or someone just like him. Someone you know was popular in high school. Someone who drips with ego. Holds his head up high. And in the process of showing his self worth, brings you down even farther. We call them narcissists here in psychiatry. But their power is undeniable. And it's hard to break free of them. So while I can't stop him from going on and being amazing at medical school, I hopefully can save one of you from feeling crushed by his ego. Maybe I'm wrong about this guy. Maybe he's reading this blog right now thinking: "is she talking about me?! I am terrified! I hate medical school! It's kicking my ass!" If he is, I'm actually sorry. I'm sorry for judging you, and I'm sorry you aren't having such a good time at it. But you'll get through it. No matter how hard it gets, you'll get through. And at the other ends is the good life.

Never be ashamed of your shortcomings of failures. They make better inspirational movies

It's that time of year again. That dreaded time of year when a few of us open up our emails to a letter that says "FAIL" in big, capitol letters. Step one results are pouring in all over the country and some of you are finding out that you did not pass. You think your life is over, that your future is bleak, that your dreams will never come true. Some of you are thinking that you might as well pack your bags now and drop out. Others are worried they will have to take an entire year off from school to retake it. You're thinking about how you'll never match into a residency in your field of choice and you might as well sign up for Family Medicine, because they are the only ones who will take you. You feel hopeless and helpless and lost. And most of all, you don't want to study for and take that DAMNED test again. I feel you friends, I was there. And I'm here to say that you will survive this. You'll make it through. And you may even still get your dream job. For the past two years you have been fed a steady diet of "this test will determine the rest of your lives." That's really stressful, to say the least. You spend two years stressing out about one single test, placing all your hopes and dreams on your ability to pass and do well on this test. Nothing else is given the level of importance of step one. It determines everything, what residency you can get into, what job you can have in the future, how well other people will respect you, what kind of car you'll drive in the future, whether or not you'll live past 50. Whatever you want to do in life depends on your step one grade. It gets so blown out of proportion that you stake everything on your score. And this is the major failing of the medical school educational system. Because step one is a test. Nothing more. It tests your ability to remember random facts about a billion things that don't really matter. It supposedly standardizes you with the rest of your colleagues around the country going through the same education. It tests your ability to take a test. It does not determine what kind of doctor you are going to be. It is not the end all be all. The major failing of the medical school educational system is this fucking test. Testing me on the finest detail of how some system works does not indicate how good of a doctor I'm going to be. It emphasizes the details with a blatant disregard for the big picture. It has everything to do with science and very little to do with the actual practice of medicine. I don't know what the hell any of that stuff does. I would NEVER be able to pass that test again. And more importantly, neither would the attendings I respect and look up to. My uncle is an amazing surgeon, very well respected. Could he pass that? Hells to the no. Half the clinic instructors that you'll rotate with will admit they wouldn't be able to take that test again. Why do you think the first two years are taught by PhDs and MDs who work in labs and do research most of the time? Because that's what a high knowledge of step one material is good for. Yes, it's important to know the mechanisms of how things work. But step one doesn't really even test your knowledge. It's a mind trap. It's designed to be a puzzle that you have to figure out. It is full of patterns. And those people who excel at finding patterns are going to do better. For those of you who failed step one, I'm sorry. I'm mostly sorry because you have to take it again, and that is the really painful part. But your life is not over. Far from it. You're just beginning on your new quest. Any residency program is still open. You're options haven't disappeared. You just have to change to approach to things. The only real failure is giving up. Things are going to be hard, and you are going to have to work harder than your classmates, those lucky bastards who passed that damned test and get to move on with their lives. But you are going to be the stronger doctor because of this experience. Take time to figure out what went wrong and how to make it better. The important thing is to learn from this set back and keep on toughing it out. How do you get through this? The first step is to know you are not alone. Eleven people in my class failed. As far as I know we all got into residency. Some took another year to do it but that was their choice. Some (read: me) scrambled but now love their lives (being a psychiatrist is the greatest thing in the world). People in the class above me failed, people in the class below me failed. Someone else in YOUR class failed. I know a girl who failed four times before she finally passed it. There are many factors that went into us failing, but none of us are stupid or ill-equipted to be doctors. I failed for a multitude of reasons. My anxiety was probably the biggest factor. I could not focus, or study, or do much of anything other than cry. I was not in the right state of mind to pass a test. My poor studying techniques were another. I didn't do nearly enough practice questions. I was afraid to ask for help. My inability to take standardized tests was also high up on that list. I suck at them. I took the MCATs three times before getting a good score. I also let way too much drama into my life. Stupid ex-boyfriend and trying to make things right! I'll blame him forever! Think back to your studying. What was going wrong? What could you have done better? Ask for help. That's probably the hardest thing for a medical student to do. We all need help, we all refuse to ask for it. Don't get tied up in what someone else says is what you should do. The student affairs office has some advice but it's generally cookie cutter advice, and it might not work for you. Going to the FALCON program in Texas might be awesome, but it might not be right for you. Take the test again when you are ready, not when someone else tells you to take it. Don't take more time off rotations than you need to. The most important thing to remember (I'll probably say that at least twelve times. Everything is important. Determine for yourself what is most important to you) is that you are the only person who needs to know you failed. Sure, whoever was on rotation with you probably figured it out when the scores came in and you ran home crying. And the attending you were working with that day may need to know why you ran home crying. Student affairs will know. And residency directors/interviewers will know. The attending on your next rotation doesn't have to know. Your best friend doesn't have to know. Your future colleagues won't ever find out. So if you are a secretive kind of person you don't have to tell anyone. I am not a secretive person (obviously) and felt it necessary to wear it as a badge of honor. "Yeah bitches, I failed step 1. But my patients like me better." I told who I wanted to. Which definitely was not everyone. I was more willing to share it after I had finished and taken it and passed it. But when I first found out I texted a bunch of my friends to let them know. Mostly for the sympathy, but also so they would know why I continued to be a crazy bitch. And that way when a couple of my friends failed they could tell me and we could commiserate together. And for those who didn't pass it they could bring me candy and feel sorry for me. I've been getting comments on my blogs from all kind of people struggling in medical school. Some failed tests, some failed classes, some failed rotations. But everyone keeps working through it. And I'm proud of all of you, because you aren't giving up. No matter how bad it gets, we are survivors. And when I go out there and look for a job I'm going to be able to sell myself so much better than someone who never struggled, because I know more about myself because of how much I had to struggle. And I'm an inspiration for others. Think about your favorite movie. Did the protagonist have an easy time of anything? No, because that movie would suck. There would be no point in watching it. So those classmates of our who go through life with everything coming easy aren't going to get to be the plot of a movie. Their movie sucks. Our movie is awesome. I want Emma Stone to play me. She's got spunk, and she's super cute. She'd make a great me. And my story is better than other people's. I had an easier time writing my personal statement, because I have something to talk about. Most importantly (there it is again!) I am a kick ass doctor. I'm in my second year of residency in psychiatry. Even though I scrambled into my program I'm one of the best residents in my class. Everyone who find out I was one of the scramblers is surprised. I teach medical students and get rave reviews. I just got an evaluation from my internal medicine attending saying I worked at or above the level of a medicine intern (I was an intern when I did this rotation). My six month reviews have consistently passed me with no concerns. My attending love me. And my patients swear by me. I'm officially done tooting my own horn, because really all I was trying to point out is that step 1 (or 2 or 3 for that matter) does not determine your ability to be a good doctor. People will continue telling you that to help you feel better, but I'm living proof that it is true. So study hard friends. Keep calm and carry on. Be proud of yourself for continuing on this crazy journey towards medicine. And remember that if you aren't struggling you aren't really living! I love you all, and wish you the best in your endeavours. Even if I don't know how to spell it :-)

If you don't want to teach, don't work at a teaching hospital

So as a psychiatry intern I have to do six months of horrible time "off service" as part of a national requirement. I have two months of medicine, two of neuro, one of emergency and one of pediatrics. I have spent the last four months working on this off service requirement waiting for the blessed moment in which I will become a second year psychiatrist and move back to my home, the psych ward. In the meantime I'm constantly reminded of the crap I went through as a medical student, mostly because many of the services treat me like a glorified medical student. And while I have plenty of crap to say on the matter, I'll just focus this blog on the title, attending who don't enjoy teaching. When I was in medical school during one of our small group gab sessions one of my classmates brought up a good point. He was talking about residents who don't teach well and how there should be some kind of system in which residents could be separated out on services by whether or not they had any interest in teaching residents. Because we all know that every rotation is based on who your upper levels and attending are. Unfortunately we all train in a teaching environment so residents have to teach. In fact, most programs are doing more to try to teach residents how to be better teachers. But a resident who doesn't take time to teach you on a rotation, you feel worthless and like you are wasting your time. Many residents take the "I was treated like shit as a student so that must be the best way to teach" approach, which can be very frustrating. And some really try. Others just want to survive their residencies so they can go on to work in some private practice in which they won't have to do any teaching at all. Either way, all residents are basically forced into a teaching position, so if some of them aren't any good at it, it's not completely their fault. Attendings, on the other hand, have the choice of where they work. So why the fuck do you choose to work in a teaching hospital if you don't enjoy teaching? If you just want to go into work every day and see your patients and go home, that's fine, but don't work in an academic setting! It really is that simple. Many University hospitals and VA hospitals have positions available for people who don't want to teach, take one of those. But when you put on your white coat and walk in the door for your week as a teaching attending, don't be a jackass about teaching. You're the one who signed up for it. Jeez. The service I'm on right now (which is not surgery) is full of high and mighty attendings who seem to think that not only are they smarter than every other doctor in the whole world but that they are supposed to constantly put down the residents and make them feel like total shit while at the same time completely ignoring medical students because they don't actually matter. I've heard the attendings tell the residents that they don't "trust" the resident's ability to read the MRI. So to me that seems like a failure of the teacher if the student can't read an MRI. Should you, as the teaching attending, sit down and TEACH the resident what you want them to be able to read. Especially since this resident one day will be the teacher? Also, no attending should look at an intern at the end of the week and be surprised that they aren't a student. Dear Lord man, pay attention to the people around you. And being a good teacher doesn't involve making students cry. So if you are too high and mighty to teach people, or just really hate being around other people, get another job jackass. The world is changing, medicine is changing, and the way people learn is changing. So there is no need to resort to the "old ways" of teaching residents. Remember, we are going to your co-workers one day, so if you want us to know something you should teach us that something. Also remember you were all students one day, someone had to teach you, you weren't always that smart (or as smart as you think you are)so don't play all high and mighty. We all go through this, lets spend some time not making it so horrible for everyone else. If school teachers taught your children the way you were treating your residents you would be FURIOUS and probably get them fired. And your kids wouldn't be learning anything. Ok, that's the end of this rant. Stay strong friends. And know at least that if you ever come across me, you'll be in the hands of a really great teacher.

What they don't tell you about survivng your clerkships

Walking into a new clerkship can be completely terrifying. What makes it more terrifying is the fear that is instilled in you before you walk in the door. Horror stories about how you will have to spend every waking hour running around doing work, seeing patients, getting coffee for your attendings, being demeaned by the residents and doctors, not knowing any of the answers, waking up at three AM to get to work and not getting home until 10pm at the earliest. Having no life outside of your clerkships. But I think the worst part of all of this is going into it thinking "and so goes the rest of my life." Because if you work that hard as a student you must be working that hard as a resident right? Well let me debunk some of the myths. Yes, the above can be your life for the remainder of your third year, fourth year, and possibly even your residency. But you don't have to let it. Because clerkships, and residency, really aren't as bad as you think they are going to be. In fact, for most people medical school gets MUCH better once the clinical years start. I still hated my life, just not nearly as much. You just have to know a few things. Here is what I learned going through my rotations to make life a bit easier: You can go to the bathroom. There is time to take a small break and run off to the rest room to relieve your poor bladder. I was convinced I was going to have to hold my tiny bladder forever, was getting ready to buy depends pull ups just in case, when I realized that no one would really miss me for the five minutes it takes to use the rest room. Of course there are some exceptions. You can't run off in the middle of a code to go potty, even if you are just standing on the side watching. Leaving the OR to potty is also a bad idea. But go before the next case starts. Leaving rounds to go to the bathroom is permissible but frowned upon. So try not to make a habit of it. Take a break for lunch. Really, as a medical student you are not so important that you need to work through your lunch break. There is always downtime to go get some food. It is ok to ask to go grab some lunch. Again, use your common sense. A code is not the appropriate time. Always bring snacks in case lunch should get delayed for some reason. Bring a book or study material. There is always down time. And you won't always have a computer during that down time. Do not show up at 4am (again, except maybe for surgery). There is no reason to be there that early. And on most rotations, except when on call, you will likely be out between 5-6pm. Afterwards, you can sit and watch tv for awhile. Or catch dinner with friends. Do not make medicine your entire life, or you will go crazy. Study while you are on the wards during down time and then take some evenings off. If there is an upper level on the team, do not let the intern boss you around. Interns have little power. I've had a couple of interns who felt it was in their job description to boss me around and tell me all the mistakes I made and make me feel as small as possible. They are douchebags. Your intern looks good when you look good. Yes, they should tell you when you are doing something wrong, but in a helpful, we all make mistakes kind of way. And they do get to assign you tasks, but they are not your boss. The upper level is. Do not let anyone make you feel inferior. Remember, everyone is there to learn, and we all learn a different way. Your main job as a medical student is to learn. Occasionally you will have to do scut work, we all did. But that is not your main job. And you don't need to make a huge show out of learning, but do make an effort to demonstrate your ability to learn. For instance, if you don't know something and the attending asks you to go read about it, the next day do bring up that you took the time to learn about it, and ask if you are understanding it correctly. Do not make a huge show of the twenty different articles you read about it. You don't have to be a gunner, but you do have to show interest and some initiative. It is okay to not know things. No one knows everything. If you don't know something, DO NOT lie about it. Never say you did something that you didn't do. Because it may come back to bite you. Remember that we all make stupid mistakes. On one of my clerkships I was evaluating a guy with stomach pain and completely forgot to do the physical exam. When asked about the exam I just said "wow, I am an idiot, I didn't do one, let me go do it and I'll come back and finish this presentation." It was no big deal. I got teased, but not ruthlessly beaten down by it. If someone is making a big show of how amazing they are at your expense, it means THEY feel insecure and need to take it out on you. Don't let them get to you. Just do your best. This is all about survival, get through it and move on to the next one. Some of the rotations you will LOVE. they will be super exciting, you'll look forward to going, you'll enjoy the work. Others are so boring you want to poke your eyes out. And sometimes the one you love is the one others hate. Who cares, it's about what you like. For the ones you don't like, put on your happy face and remember it is only a month (or eighth weeks tops). And let yourself enjoy things. I even enjoyed some of my surgery rotation, and I hate surgery. But when I liked something I went with it. I actually hated very little of my rotations. I was surprised by the ones I liked. Go home when someone tells you to. Just do it. Offer to help one last time, then if told to go home again, just go. Pay attention to the lifestyle of the residents, their stress level, the work load, and the hours. Because these are things that help you decide what you want to do with your life. You can absolutely love surgery but hate the lifestyle. So then pay attention to things you enjoy that have procedures, because there are other jobs that involve procedures that you may be able to do without the hectic life of a surgeon. I, for instance, hate procedures and am so excited to finish my off service months so I can go back to the comfort of psychiatry where the only thing I have to do is talk and listen. And give drugs. Ah, the life. Also, don't feel bad about what it is you like. I know I felt like if I went into psychiatry I would not be a real doctor and why go through all of medical school to just go into psychiatry, and so I decided to go into peds instead, andthank goodness I didn't get in because being a "real doctor" is totally over rated. I would have hated being a pediatrician! I LOVE psychiatry. And I don't care who doesn't. Because it is my life, not theirs. So do what you love. Last bit of advice. You are still a human being with things that cannot always be taken care of on your one sunday a week off. So sometimes you have to schedule an appointment of some kind into the afternoon. It is okay. Don't take everyday of the week off. But go see your doctor. Take your car in. I once left work early to pay a parking ticket. It was embarrassing to ask for the time to do it, but it couldn't wait any longer. I also would sometimes leave work early for therapy if I couldn't get a later appointment in the evening. It is ok to do every once in awhile. And that's all I can think of right now. I'm back to feeling like a medical student now that I'm on internal medicine again haha. Except when we round I don't have to go into every patient's room, and when we are done with my patients I can go back to work haha.

do you really think I have nothing better to do than go to mandatory sessions?

This one is for you, "anonymous!" because that last one really was also for you. You also gave me the inspiration for this latest blog. Something else I'd forgotten I hated about medical school: mandatory sessions and evaluations. It's like they didn't think I was doing anything with my time, so had to fill up any little bits of freetime with extra sessions. Why do they do this? To torture me. I know it is a plot against me. Seriously though, why do they make everything so freaking difficult? And none of it seems to even matter. At my school we used to have "communications" session, where we had a difficult topic and had to do an interview with a standardized patient to learn how to talk about these difficult issues. I actually kind of enjoyed these sessions, except for the fact that they were ALWAYS the same week as a test. No matter how many time we filled out evaluations BEGGING them to switch days that never changed. I'm not sure how many nasty evaluations I filled out "please schedule these sessions, which are very helpful to our medical education, when we don't have a test the next day so we can actually feel like we are learning and not dreading being there." But alas, no change. At least those sessions were worth my time. I learned something, most of the time. There was the odd time that the facilitator felt he needed to give really specific feedback. Never again will I ask for specific feedback. Seriously this guy wrote down EVERYTHING I said to the patient and then repeated it all to me and judged every sentence. Calm the fuck down dude, I want to go home. Other sessions you are literally sitting there wondering why anyone thinks any of this is important in any way. We had multiple sessions that were supposed to cover things that we don't really learn while in school. Like hospice care. Or medical billing. Or...nope those are the only two that were even remotely helpful. The others were just sessions where I sat there staring at the wall, wondering why I couldn't go home. Why? Because there might be a sign in sheet passed around, and if your name wasn't on it, there was hell to pay. How did people get through medical school before iPhones? Because without phone solitaire, facebook, and text messaging I would have died of boredom. Also it was nice to get the "get your ass to class there is a sign in sheet" message if you were running late and debating coming. "On my way!" haha. The worst, worst worst worst though are the small group sessions where your facilitator really feels the need to spend EVERY second of the allotted time. LET ME GO! I don't want to hear any more stories or tidbits of information. I want to go home and stare at the walls and hate my life in privacy. Thank you. Even in residency we have didactics/lectures, and sometimes you just want to strangle the facilitator so that he will shut up and stop speaking so you can go home. And that one person who keeps asking questions. "any last questions?" NO! Everyone shut the fuck up and start packing up, because once you get them started you know they won't stop! And while I can fall asleep in a large lecture hall, it's more difficult to get away with things when there are only four people in the room other than the speaker. They usually notice that shit. So some things haven't changed since medical school ended. One is my crazy ability to fall asleep at any lecture. Journal club? Why yes I do need a mid day nap. Grand rounds? I actually look forward to them as "naptime." Didactic? Fellow residents have to poke me and throw me gum to chew to keep me awake. Another thing that hasn't changed: my time being taken up by stupid ass "learning opportunities." that I'm sure someone out there finds helpful but I do not. And I will never ever get used to attendings that need to perseverate when I could be going home. Weekends are not time to be teaching! They are time to round and get the heck out of there. The end of the day? Stop talking I want to go home. I don't learn anything at those times. Please respect my need to get home. But nothing is as bad as medical school, that is for damned sure. I have very minimal complaints about residency, so stick with it friends. And go into psychiatry! That's the life :-) Good luck and good night everyone!

For those of you who read my blog, I love you!

Just wanted to say a quick hi to all those blog readers out there. All five of you haha. I also wanted you to know that I love the comments you leave on my blog and I'm hoping that thisblog helps some of you feel less alone out there in medical school. I absolutely hated it, but I made it through. I am enjoying my residency in psychiatry. I really hope that it is worth it for all of you out there struggling through the process of medical school. I hope that everyone enjoys their decision to go through medical school and become a doctor. I'm not even sure I'll continue to love it, but for now I'm enjoying it. I'm glad to be out of medical school and hope things will continue to go well. You'll all be okay. And contact me if you feel any need to! I'm here for all of you! It's going to be okay, and the adventures of residency are a fun story all in themselves. Good luck out there!

That awkward moment between graduating and starting residency when you have no clue what to tell people you do

So it is official, I got to graduate. I am an MD. I am a doctor. I cannot believe it. I was waiting for something bad to happen but for once it didn't. I was allowed to graduate! Now I am sitting in my new apartment in my new city waiting for residency to start and I can't believe I am a doctor. It definitely hasn't set in yet. I was sitting in the spa the other day, filling out a form before getting a well deserved massage, and I was asked for my "occupation." I didn't know what to put! For the past four years I have put student. But I'm a graduate now. Yet I don't consider myself a doctor quite yet. Mostly because I have no real training yet. I've got this MD and I don't know how to do anything with it. Or even what I'm supposed to do with it. I'm not really unemployed because I signed a work contract but I haven't started my job yet so I feel unemployed. I don't feel a like a doctor. I'm terrified if I tell people I am one they will start asking me questions that I can't answer. So I'm a doctor, what does that even mean at this point? Here I sit, relaxing because I don't start intern year for another week, wondering how I am going to survive. I pretty much haven't done anything for the past three months. How am I going to start working again all of a sudden? How am I going to ever convince myself that I am a doctor. When does that happen? I totally feel like Eliot Reid on Scrubs when she could never explain what it was that she did. And JD was like "you are a doctor." I odn't feel like one. And my mom loves to run around telling everyone that I'm a doctor. And for about a day I loved it too. Now I am not sure I deserve the title. Awkward.

Scrambling fucking sucks, but you get over it eventually

What a freaking year! I'm sorry to my faithful follower for not posting in awhile, hope anyone reading this is doing well. What has been going on in my world since I last updated my blog? I high passed my cardiology rotation, which was impressive considering I half assed the shit out of it. Word of advice: if you can pick who evaluates you, pick the people who think you are doing a good job. I wasted a shit ton of money on interviews thinking I wanted to be a pediatrician. I thought I got really good feedback and did pretty well. There were a couple of places I absolutely LOVED and really wanted to go to. There were a few places I had nightmares about being matched at. I was exhausted by the end of my season, but overall I felt pretty good about things. I still had this slight nagging suspicion that I might not match, but it was just one of those "you've sucked at everything else, so why wouldn't you suck at this too?" type feelings, nothing really concrete to support it. I even got a really great email from my number one choice, from one of the people who interviewed me saying she was so happy to have met me and really thinks I'd be a great fit for the program and that everyone really liked me and I was a delight and blah blah blah. So at that point I was getting pretty confident that I was going to get my top choice. I even started apartment hunting, just little things on craigslist and whatnot, just to see what the market was like. Boy did I jinx myself. DO NOT START LOOKING AT APARTMENTS UNTIL YOU MATCH. Because let me tell you, overconfidence is a silent killer of medical students. Here is how match week works, for those of you who are getting close to your fourth year. In February you put in your rank list. Then you sit there until the middle week in March, twiddling your thumbs and wondering where the fuck you are going to be spending the next 3+ years of your life, and rethinking every decision you've made, and questioning your judgement, and wondering why you are STILL in medical school and if you are ever going to get out of there alive, but really probably not doing much else with your time. Then, it is finally Match Week. Monday you get an email saying whether or not you matched. Friday, if you were lucky enough to have matched, you open your envelope and find out where you are going. You spend the rest of Match week feeling smug and complaining about how you don't know where you are going yet and it is just so exciting. Fuck you. Here is what happens when you don't match. First hand experience here ladies and gentlemen, you can't find better information than this. You get an email from the NRMP with a subject line that says "did I match?" and you get all excited and get butterflies in your stomach and then you go somewhere private to open it just in case and the first thing you see is "No. I'm sorry but you did not match." Similarly to opening that email that says you failed the boards, you read it at least five hundred times over and over again, not believing it, wondering why this is happening to you, and generally are in a state of complete shock. Then you realize you've got to go fix your life AGAIN. If you are an idiot like me, you're in the middle of a rotation (luckily just watching movies) so everyone knows that you didn't match. And by everyone I mean 14 people. Then all your excited friends start texting you to find out if you matched, and you get to start telling people that no, you did not. Then you burst into tears and call your mom because really life cannot be any worse. But then, you pull yourself together. Not because you are strong and amazing, but because you have no other fucking choice. Four years of medical school are about to go flush themselves down the toilet if you don't scramble into a spot. They created a new system for us, and let me tell you, it is actually kind of nice. You go upstairs and find all the other people that had to scramble (hey buddy, fancy meeting you here) and sit down with your speciality mentor and cry for a bit. Then you get this list of all the open programs that you can apply to. You send out your application and wait. Later that day the schools start calling you. Because they are freaking out too. Holy shit we have open spaces! We must fill them! You spend a day and a half doing phone and skype interviews and then on Wednesday morning you hope to GOD someone liked you enough to take you, or at least that they are desperate enough to take you. Wednesday you sit down with your computer and the first round draft begins. If you are lucky (like I was) you get an offer right away. Some get more than one option and can choose where they want to go. Some unlucky bastards don't get accepted anywhere and have to wait two hours to see if another offer comes in. Luckier people find out where they are going on Wednesday, go home and spread the good news, and pass out for the next day. Masochists like me decide to still go to Match Day brunch and try to be happy for others while secretly hating them just a little for the ease with which their lives pass. What else happens that week? On Monday I got many "you'll do great we love you" texts from friends. I also went to a brunch place and had the most awesome French Toast with cinnamon and caramel and deliciousness to drown my sorrows. I then went back to my house and refused to talk to anyone except the few schools that called me. But, I also made a very important decision. Fuck pediatrics. Maybe the reason I'd been freaking out so much for the past couple of months is that I didn't actually want to be a pediatrician. Maybe all my wonderful experiences in psychiatry, my love of difficult situations and talking to people, my fear of procedures and hatred of much of medicine, were really a sign that I wasn't supposed to go into the field I thought I was supposed to. Bright side! I changed professions before it was too late. All that debating about whether or not I should go into psych instead of peds was decided for me. Peds didn't want me. So try something else. So I re-applied to pediatric programs and applied to psych programs. And I only heard back from psych programs (well, one peds program but that was it). And psych sounded nice. Good schedule, nice people, lots of options. And you wonder why you spent thousands of dollars interviewing when you could have just scrambled in the first place (risky, don't do it) and you try to cheer yourself up. The rest of the week is spent reminding yourself that everything happens for a reason. Because it does, I'm likely to be happier in psych than I would have been in peds. This may have been a sign from God to change my course (why he couldn't have told me BEFORE is beyond me), and I'm really probably going to enjoy my new field more. That doesn't change the fact that you feel like you've been punched in the face so hard you are amazed nothing broke. It is the worst blow to your professional self esteem. And you wonder, what the FUCK did I do wrong at my interviews? Because although I heard many a "any program would be lucky to have you" at the end of the day not a single one wanted me. And that is a hard thing to get over, even if you are happy with where you end up and how things worked out. It may have all been for the best, but it is the WORST way to find what is for the best. Every action for the last four years has been re-thought and re-played and I wonder why I suck so damn much. They tell you that the scramble is completely anonymous, the only people that know are the Dean of Student Affairs, you, and the program you join. But that is a load of horseshit. Because people text all day on Monday "did you match? did you match?" and you have to make the choice: do I lie? Or do I just own up to it? Also, you've spent a lot of time talking to people about where you interviewed and where you liked, so come Match day, if you mention some place you've never talked about before, people figure it out. Also, if you change specialities like I did, people figure it out. But, you can fuck with people a little bit, which is always fun. I enjoyed seeing the expression of people's faces when I told them I was going into psych and they were like "wait, I thought you wanted peds" and I just walked away. Or the guy who when I told him where I was going said it was a nice place and I blurted out "I don't know, I've never been there." And he was like "except on your interview you mean." And I was like "nope, didn't go there. Didn't have an in person interview there. I've never been." I really wish I'd just left him to wonder, but I eventually told him where I was going. Match day, for those of us who scrambled, SUCKS. But it shows a nice level of maturity to go to it. And it is nice to see everyone else so happy. Even if you want to die a little inside. Screams of joy, some tears are not of joy, everyone excited to start their new lives. Not everyone is happy on match day, but it sure feels like it. So forever I'll be the girl who scrambled, just like I'm the girl who failed the boards. No one has to know, but I'll always know. I am happy to be going into psych and into the program I'm going into. It's going to be awesome. But I will likely never fully get over the hurt of not matching. I spiralled into a crazy depression, one I hadn't felt since failing the boards. It sucked. But I lived through it. And I'm moving on. Moral of the story: things suck sometimes, but you get past it and move on. New adventure, about to begin. This hell called medical school is almost over. To all of you getting ready to embark on your fourth year, good luck. I have no useful advice to anyone that I'm willing to share, because I don't want anyone to end up in my position and I feel like my advice would just put you in that position. So do what you think is right and be ready for whatever comes your way.

I'm pretty sure I'm being ball blocked

I'm very frustrated right now. With the man. The institution. What the hell is going on? I'm trying to create positive change on campus and I feel like I'm being blocked on all sides. Like there is some force that wants to silence me but not let me know I'm being silenced. I'm being put to a task with no ability to move forward, but they are trying to convince me that I'm an integral part of the team. I'm being humored. That's the word I'm looking for.
I understand that I'm loud and crass and tell it like it is. I complain about things and I'll point out the shit that is going on. Hence this blog right? But I'm also trying to help fix thing. Trying to help keep other medical students from going through the same shithole experience that I went through for the past four years. I want people to be better, I want this institution to improve and thrive. I want this to be a place we can all be proud of. But my methods aren't as PC as people would like them to be. So I get black listed.
There is something going down on campus that I should be involved in. I've been trying to create a mentoring program for TWO YEARS now, and no one has stepped up to help in any way. I've been met with resistance. And now here is a group of other students popping up, trying to take over my baby and do it their way, without letting me be part of it. It's a conspiracy I tell you, and I usually don't believe in conspiracy theories.
Well, if you don't want my help you aint gonna get it! Just tell me to my face and stop wasting my time, because I have other things I could be doing right now! Like catching up on old episodes of Friends. And going to the gym. And RELAXING. So what's the dealio?
Hmmm...
something sketchy is going on around these parts! And I won't rest until I get to the bottom of it. Actually that's not true. I'm just going to stop trying to help and let them figure it out for themselves. Don't want my help? Fine, you won't get it.

"Any residency program would be lucky to have you."

I never thought I'd hear such a complement on my interview trail, especially not at my home institution. Today was my sixth interview, the one I was least excited about. I am definitely done with this state, and feel like you have to have had really positive medical school experience to want to stay at your home institution for residency. That's right all, I'm a fourth year. And it is kicking ass, now that I'm in the middle of it. I haven't blogged in awhile, but lets just say that things haven't been getting much easier from all the rants I've posted so many time before. I had a horrible sub-I experience that left me feeling like the worst student in the history of medicine, and very close to dropping out of school. Yes I say that in almost every blog, but here I was, finally decided on peds, excited to get started,ready to prove myself, and instead proving that I'm just an idiot with no talent and no ability to be a doctor. The sub-internship is a difficult place to struggle. You feel like you should be good at something and when you aren't, you wonder about your career choice and the rest of your life. And when you are in a state with only one option for a pediatric residency, you don't realize that just because one program doesn't work for you doesn't mean you aren't going to find one that does.
I spent a good portion of the end of my third year and beginning of my fourth year thinking that residency was going to be this hellish experience that I was just going to have to get through and hope that real life practice was better. Considering I've spent the past three years hoping everything was going to get better it was kind of a depressing thought to resign myself to more years of horror in the hopes of things getting better. Luckily, I figured out that part of the problem with the program at my school was that it was just to big,and I didn't like big. I wanted to go back to small. So I started looking for smaller programs, and I've found some amazing programs to apply to.
during the interview process I've found that I could conceviably be happy in any of the schools I've interviewed at so far. Really, honestly, happy and enjoying residency. I've even found a program that I think is perfect for me, even if the location is less than ideal. Who knows though, maybe I'll love the town once I get there.
But what really surprised me throughout this experience is that I'm a really good residency candidate. Yes, me, failed boards, bad attitude, and inability to learn. Why? I'm not quite sure. Apparently all the other stuff I've done in medical school has turned out to really work in my benefit. Maybe I'm just applying to places that want something more than a boards score. Or maybe, just maybe, failing the boards and struggling through medical school has actually made me a stronger, more in tune with myself person. Maybe the fact that I have to explain over and over again why I failed the boards and what I learned from it is actually working to my benefit. And I'm finding that saying "failing the boards sucked, but was actually a blessing in disguise" isn't just some line I'm spouting, it really is true. I mean, I'd rather not have failed the boards, but what if I had just barely passed? Where would I be now? Still thinking I'm the dumbest, most unteachable person in the world? Because now I can see that maybe I'm not as smart as everyone else, but I'm sure not dumb, I just learn differently. Would I have learned that I learn differently if I had never been forced to face that fact? Interesting...
When I started picking school to apply to for my residency, I wanted school that wouldn't care quite as much about my failure as they did about the fact that I do have some things to contribute to a program. However, being a student allowed me an interview at a top ranked program. A wonderful, courtesy, you go to the medical school we are affiliated with but have no chance of actually getting into here interview. And to be honest, for as much as they probably don't want me, I didn't want to go there either. I don't think they have ever accepted a boards failure before, and while I'm more than willing to be some program's token Muslim, being the token board failure didn't seem like something to be bragging about. So when I got to my interview today, I was expecting the worse. I was all geared up for a fight. I seriously, genuinely thought that they were going to sit me down in my interviews and say "why in the heck should we even consider you? Because right now as it stands, you don't have a chance in hell. You know that right? You would never get in here." Or some variation of that theme. And I was nervous about it, but also kinda ok with it, because it's a mutual understanding that I don't belong there.
Well, as in most times when I've geared myself up for a fight, everything actually went really smoothly. And strangely, though nothing I heard today made me think this progam would be a good fit for me (even though it is a FANTASTIC program, with some of the best facilities and learning opportunities a student could ask for), I left glad that I had gone. I remembered my bad experiences there, but I also saw it through the eyes of other applicants, and really wanted to want to go there. That makes really great sense in my head. I loved the state of the art facilities, I remembered how much I felt like if I had sick kids I'd want them treated there, and I appreciated what the program had to offer. But most of all, I had two amazing interviews with physicians who made me feel valued. My interviews were the opposite of what I'd been expecting. Two amazing physicians from an amazing, highly ranked program with all the applicants they could possibly dream of, telling ME, little old me, that I was an amazing applicant with great experiences and insights. And at the end of the my second interview, the doctor said any program would be lucky to have me.
When it comes right down to it, I still don't think they are going to rank me very highly on their list. I mean, come on today we had students from Duke interviewing. I can't compete with shit like that. But I left there feeling like someone who, with hte right amount of training, can go out into the world and do something special that others might not get to do. And that was one of the best feelings I've had in a long time.
So, for those of you who read my blog (which I'm sorry I haven't updated in awhile) and feel like I do, that everything is falling apart and there are just so many more years of hell in front of you, remember that everything that is happening now is worth something, making you stronger, and helping you to become the best doctor you can be. And that isn't just smoke I'm blowing up your ass. I really am starting to think it is all going to work out.

My freakin' awesome pediatrics personal statement:be jealous

I never realized how important it is to dream until I discovered I’d lost my ability to do so. Ask a child what they want to be when they grow up, and they have such large, vivid dreams that no one can take away from them. When I was a child I wanted to be a princess, and a ballerina, a fashion designer, travel the world, and be a doctor. All I had to do was dream. None of my dreams conflicted with each other, there was always time for all of them, you could be a fire-fighting princess teacher if you wanted to be. All you had to do was grow up. Growing up was the key to fulfilling all dreams.
During the process of growing up, I realized that my dreams did conflict with each other, and my vision became more concentrated and focused. Medical school narrowed down my focus to the business of becoming a physician. Focusing on the moment and succeeding in each of my classes was essential to fulfill my dream of being a doctor, which seemed like such a huge accomplishment in and of itself that I forgot that I could be so much more, and that being a doctor meant so much more than just earning my degree. And when I failed the boards, I felt like becoming a doctor was just that, a dream that was slowly passing me by. But I picked myself up, recognized the weaknesses that had kept me from passing the first time, and worked hard to pass it the second time around. As I continued through my clinical rotations, I was working to reach an endpoint, a fixed goal, instead of remembering all the dreams I’d had for what I would do when I “grew up.”
I started noticing a difference during my pediatric rotations. At first it was unclear to me exactly what had changed. I assumed it was just the magic of being around children all the time; however, I soon realized I was starting to get my dreams back again. And by dreaming big, like a child does, my enthusiasm for my future was renewed. I was excited to see what each day had to bring, what new cases there were to see, and how I could be part of a child’s care. When children shared their dreams with me, I was able to share my dreams with them, and show them that dreaming never has to stop. Now I want to show them that they can fulfill those dreams, maybe with just a few adjustments.
I came to see that during the process of growing up, children’s dreams are slowly stifled. In very young children, we encourage large, intense, somewhat ridiculous dreaming. As kids grow older, parents and society start having expectations of kids that can sometimes restrict their dreams. It’s all part of the process of growing up. But I feel that through medicine I can work with children to keep them healthy so they can continue to dream. Additionally, by living my own dreams, I can provide opportunities for kids to live their dreams.
So while I have accepted that I may never be a fire-fighting princess fashion designing super hero solving mysteries and saving lives, I’m realizing I’ll never “just” be a doctor either. Children believe they can do many things all at once, and by being around children I’m able to hold on to those dreams of being many things at once: a doctor and a teacher; a mother and a therapist and a world traveler. And most importantly, I’ll be saving the world, one child at a time, just like I always knew I was destined to do. Children gave me back my ability to dream, and I now will dedicate my life to giving them everything I can dream of.

The third year tremor

I happen to have a slight tremor in my hands, which is making my surgery rotation quite difficult. However, I recently heard of this "third year tremor" and it made me wonder, where does it come from? Is it from the late nights, lack of sleep, increased coffee that comes with third year? The stress of trying to impress residents, attendings, patients, classmates, residency directors, the whole wide world? The fear of making a mistake? Or is it from holding so many damned instruments for long periods of time during your surgery rotation? Either way, after third year you are never the same.
I often wonder what other medical conundrums you get from third year. Is there a return in incidence of nightmares or sleep terrors? Or is that just me. Has anyone else noticed a fake plastic smile stapled to their face? Is that going to eventually cause some twitching in my cheeks? Is there an adverse effect from trying to hold back tears and hold your face perfectly still so that your attending doesn't realize that he is getting to you? How about GI upset from all the coffee, stress, fast eating, hours of not eating, dehydration etc etc and so forth? I know I've got narcolepsy that is definitely enhanced by third year. Has anyone else noticed a total lack in concentration? I've got ADHD up the wazoo, I think it is from too many hours of rounding on patients. The more I try to pay attention the more trouble I have. I'm starting to think I have absence seizures. How about the neurological signs like like word finding difficulty? Not only do I have trouble figuring out what I'm trying to say when I'm presenting a patient, but I've also noticed that in general conversation I now lack the ability to express myself, because I can never remember the word, and I can't figure out how to use another word to describe what I need to say. I also stop abruptly in the middle of sentences, probably because my brain is busy trying to multitask.
What other symptoms have come along with third year? Of course hanging out around sick people all the time can make anyone start to think they are sick as well, but there are certain things most medical students notice about themselves as they go through the year. Many of us become more hardened and apathetic. Our trust in what a patient (or anyone) is telling us decreases as we go through a year of lying and manipulating patients. Our social awkwardness increases secondary to a lack of normal social interactions. Things stop surprising us, because we've heard and seen worse. And the strangest, little things horrify us while large things that would horrify others no longer affect us. How many other medical students have heard a story about someone getting hit by a car and been more worried about the person's dog that wsa also hit than about the patient. "Oh the guy died? What about the puppy? Oh thank goodness he is fine! He lost a leg?! That is the saddest thing I've ever heard. Poor puppy." What is that about? Priorities definitely change.
The worst thing third year brings about is also the one that most people won't talk about, and that is the increased depression. Third year is fucking hard. I still prefer it to the other two years,and find myself a bit happier than I was second year. I'd rather go through my toughest days of third year over again than any day of second year. But third year comes with its own bag of insecurities and sadness. An overwhelming feeling of insignificance and incompetence surrounds me daily, even when I'm doing well on a rotation. I have noticed a complete lack of interest in anything not related to pediatrics, to the point where I'd skip out on surgeries if I could, and I have to muster up all my energy just to go to rotations every day. I find that things that excite other students do nothing for me. I couldn't care less about procedures. I'd rather not be responsible for doing them. I don't want to scrub into a surgery. I don't want to round on my patients. Especially now that I'm at the end of my third year, I don't want to do any of this stuff anymore. Where did this apathy come from? What happened to my passion? All I want to do all day is go home. And once home, I don't have anything to do, nor is there anything I really want to do. I could look forward to a bike ride all day but then get home and decide not to go out on my bike. And I keep telling myself that it is just because I am not interested in anything but pediatrics, and everything will be better once fourth year starts, but what if it isn't? What if medical school has taken my passion away completely? All of my interests are gone, partially because I don't have time for anything. And some times are better than others, but this rotation has been especially hard. And I'm worried it isn't going to go away. What if, even though I love pediatrics, I'm forever this uninterested, bored, tired, and lonely. I sure hope not.
I hope that when I get into something I enjoy a little more, or finally find my niche in life, my passion and interest and love of life will return. Until then, I'm just trying to muck through these ridiculous assignments and rotations, jump through the flaming hoops and land on my feet at the end of all of this. Now I just have to figure out when "the end of all this" is going to be. Because these third year symptoms my never go away...

I can't have another evaluation saying I show no interest, so I better learn to fake it

There are a lot of things that are difficult about third year. The hours, the stress, the lack of knowledge, the trying to figure out what you want to do for the rest of your life. But by far the hardest thing to do is pretend and show that you are interested in EVERYTHING. The beginning of the year you ARE interested in everything. Or at least you think you are going to be. You start the third year thinking that even if you don't want to go into surgery, or neurology or whatever, you are still really going to enjoy the rotation, and you'll learn something great in each one. And while it is true that you will learn something in every rotation, I have found it very difficult to keep up a level of interest in things I couldn't possibly care less about. Unfortunately, this is an integral part of the game. A game I suck at.
Somehow I grew up thinking that I masked all of my emotions very well and no one could ever tell what I was thinking. I'm still convinced of this, even though repeated it has been pointed out to me that I am wrong. My mother, for instance, has always said she can tell when I'm upset about something because it is written all over my face. And classmates constantly tell me they love watching my facial expressions during classes/lectures when I am not happy about what is going on. Apparently I am their source of entertainment in really boring moments. And at least three times this year I've been told that I lack enthusiasm and don't appear interested. One resident told me she could always tell when I'm bored. This is no good, because quite honestly, I'm bored a lot of the time. My attention span just doesn't last very long. And I don't know how to fix that.
This is my great challenge of third year, which is now almost over. Trying to figure out how to convince people that I'm interested. Because even when I am interested apparently I look bored. Much of it is my lack of ability to play the damn game. The bring in articles, ask a million questions, show off my knowledge randomly, suck up entirely and always be working hard, or appearing to work hard. I can't play that game, I'm tired and burnt out. If I don't know something one day, I'll look it up that evening, but I'm rarely able to then track down my attending and tell him everything I learned about the topic I didn't know anything about before. Not because they aren't around, but because I literally cannot bring myself to be such a suck up. But that apparently makes me look uninterested and unwilling to learn. So sometimes I bring in an article, but that doesn't seem to impress anyone either.
And sometimes I'm just a quiet learner. I don't like to ask questions during a surgery. I like to watch and concentrate on holding what I'm holding or retracting what I'm retracting. I don't want to spew out bits of information about the surgery unless asked. And I don't want to find "interesting" surgeries to go to, because those are long, and I can't handle long. Last week I saw an open heart surgery. Coolest thing I've ever seen IN MY LIFE and I was still bored in the middle of it, wanting it to end, and unable to concentrate on the whole thing. And super glad I wasn't scrubbed in, because I could not have stood for that long. But I was totally fascinated and enthralled by the surgery. I doubt the surgeon could tell though, because I wasn't asking a million questions and pointing out all the stuff I know. I was just watching in awe of his magnificance and the fact that you can stop a beating heart and keep a person alive.
So now I've had three evaluations that say I don't seem interested. And this surgery one will probably be the same. So how do I counter this attack? I've tried a couple of things. I've tried being that annoying student who brings in a bunch of articles and STILL one of the residents wrote I didn't appear interested. It's because I phase out when someone is talking to me for too long. I just can't deal.
Does this make me a bad doctor? I sure as hell hope not. And I don't think so. Is anyone really interested in everything that happens around them during the day at all times? Does that make them bad people? I care about my patients, how come that doesn't come up in my evaluations often enough? Sure I'm bored with neurology, but I sat with a patient for ten minutes comforting her over her diagnosis. Yeah, maybe I don't ask questions while in surgery, but I sure as hell make sure when he comes out of surgery that patient gets a warm blanket right away, and that he isn't in pain. And maybe I don't look up articles about some seizure disease a baby has, but I'll sit there with the parents holding their baby while they cry and pray with the pastor after finding out that their baby might not live. And I don't do any of that for the fucking show of it. I do that because that is why I went into medical school. I didn't go into medicalschool to be a suck up, to be fake, or to prove anything to anyone. I went into medical school to become a fucking doctor, someone who cares about others and helps them through hard times.
Maybe I'm not like the other students and doctors. Maybe all of them really are legitimately interested and excited about everything. Maybe they all just love learning so damned much that they never take a second off from learning to be a real person. Maybe I'm not cut out for all this crap that it takes to become a doctor. Maybe I won't be as great of a doctor because I don't have a lot of interest in everything. But I get the job done. I learn. I care. I try. I know I'm going to work hard for hte rest of my life and I'm okay with that, excited for the challenge even. But I have no attention span and I look uninterested. So I may not make it through this year. And I guess that is just the way it is. My original goal for third year was to pass everything, just pass, and hopefully high pass or honor a couple of blocks. And I've managed that thus far. But my new goal is to not get any more evaluations that said "student looked like she was uninterested." Unfortunately, I am just that, uninterested.
Is this over yet? I just want to be a doctor...

Am I really smart enough to be a doctor?

Some days-okay every day, but some days more than others- I really wonder if I am actually capable of being a physician. Mostly it's when I'm around other students. Or being asked questions. Or in any clinical situation whatsoever. My first two years of school it was easy to blow things off, and tell myself that I'd figure it all out and knowing all these tiny details wouldn't make me a better doctor. I told myself that test grades didn't determine my ability to be a good doctor. It was all about the clinical skills and knowledge that I'd gain over my third and fourth year. But as I reach the end of my third year, I feel like I don't actually know anything, still. My faith in my ability to be a doctor is severely decreasing every day. I can't answer questions that are asked of me, but I feel like all the other medical students are able to. I've heard that I don't really learn anything about medicine until I'm an intern and a resident, but somedays I feel that is just another way of allowing myself to live in denial about my inability to think well enough to be a doctor.
The first day of a new rotation is always the worst, but sometimes it doesn't get any better than that first day. Sometimes I just continue feeling like an idiot. I can't do anything right. I don't know anything. I'm terrified of everyone because I don't think I can make them better. I've already ruled out any profession where on a daily basis I am directly responsible for numerous life and death decisions (ie Emergency Medicine or Surgery) because I know I can't think on my feet the way I would need to in those situations. Maybe that is why I enjoyed outpatient pediatrics. I didn't have to save any lifes. Everyone was relatively healthy, even those who were sick. I didn't feel responsible for life or death decisions. But even in the outpatient world, there was plenty I had no clue about, so many things I didn't understand or know how to deal with, but I feel like I saw them a million times over and still can't figure them out.
So here I sit, three shifts into an emergency medicine rotation, watching physicians run codes and remember what they are supposed to do, and I can't even remember how to do a full neuro exam on a patient, or remember why I might need to. I can't answer a patient's questions about PAD or PID or UTIs or anything. I'm grossed out by half of the patients I see in the ED. I can't stand the noise, the smell, the shear number of people. It is too much for me. I don't like doing procedures. And it all stems from a feeling of inferiority and stupidity.
A doctor once told me that third year isn't really about learning how to be a doctor. It's about figuring out what you want to do and what you like, and learning how to learn. I don't think I've learned how to learn yet. I don't remember things I've already learned. I don't enjoy researching new things. I can't keep all the information in my head.
Another doctor told me the three things you need to be a good doctor are 1. a good personality so people will want to come see you (done), 2. efficiency (gots that) and 3. enough knowledge to function as a docto. That's the one I'm worried about. I liked him, because he said I didn't have to know everything about everything. I didn't have to have all the answers all the time. I didn't have to be a specialist in my field or any sort of genius. I just needed to know enough to deal with things as they came up, and know where to look when I didn't know the answers. That's the worry for me.
I used to want to be a specialist in some field. The fore-most knowledgeable person in whatever it is I choose to do. Now I just want to survive. I don't have enough faith in myself to think I'm going to be anything better than a mediocre doctor. I definitely will be depending more on my personailty than on my actual clinical knowledge. So I'd better work in a place where I don't need to know all that much, or I'm totally screwed.
Will I ever actually be a good doctor? The fact that I don't know much right now isn't an indication of my inability to ever know things right? I'll eventually learn won't I? Experience, practice makes perfect, all that good stuff? Seeing, doing, teaching, eventually knowing? I have to hold on to that hope or I won't be able to function any longer. I can barely function now as it is...

If you are not evaluating me I feel no need to impress you

Lately I have found that I only have so much energy to give. I cannot be "on" all the time. So I have found that if I don't think you are going to directly evaluating me, I won't find any reason to suck up to you. In fact, I may not even be willing to talk to you. You mean nothing to me. Maybe I'll be nice to you at least, but probably not. I can't expend energy on people who aren't going to have some kind of say in my future. I have to do way too much sucking up in my time as a student. I can't care all the time, I'm sorry. So if I find myself in a situation where I am with someone who is not going to evaluate me, I find myself not giving any effort. Not just giving less of an effort. No effort whatsoever. I will walk out of clinic early because I know you aren't going to say anything to anyone because you don't know who to tell that I'm not doing my work. It is awesome. Fairly liberating. I should care a little bit, but I just don't.

Aparently everyone can tell when I'm bored. Which is always

Something I am slowly learning about myself: I don't actually care about anything anymore. Medical school has sucked the curiosity right out of me. My attention span is about the size of a peanut. Rounds: boring as hell. A "good learning opportunity." Yeah, if I could pay attention all the way through rounds maybe I would in fact learn something. But my ADHD (self-diagnosed) will not allow for that. I can pay attention to maybe two patients that aren't mine. And if your presentation is more than one minute long, you can bet good money that I won't be listening anymore. I don't find "self directed learning" time to be useful, it turns into nap time for me. I'm not willing to spend any more time looking something up than it takes to read an up to date article. By the time I get home I couldn't care less about anything I saw during the day. And if you ask a question at the end of a long clinic day, I'm going to punch you in the face. I honestly don't care about the answers enough to spend another ten minutes hearing the answer.
Does this mean I'm going to be a bad doctor? I sure hope not. I really don't feel any need to add extra work to my schedule. I don't look for extra stuff to do. Either you keep me constantly stimulated or I'm going to be asleep in the corner. I don't give myself assignments, I don't go searching for someone to see, I don't ask questions so attendings notice me.
All of this is bad. Very very bad. Because people are starting to notice. People who write my evaluations. Those people. Apparently I wear my emotions on my sleeve and everyone can tell when I'm bored or annoyed, which tends to be all the time. Sometimes even with patients I'm bored. Depends on the day. Usually I'm not. Usually if I'm with a patient I'm the happiest person in the world. Unless it is getting close to the end of the day, and this one patient blathering on is keeping me from going home (where, in case you are wondering, I am also bored) then I get a smidgen annoyed. And if clinic has gone late, I sure as heck am not going to ask my attending any questions, even if I really want to know.
Why? Because then things like today happen. I asked a simple question (what is the difference in prognosis between two diseases) and got a ten minute answer. Then, the other student felt the need to also ask a question so he wouldn't be shown up, and then the attending ended up on a half hour soap box about God knows what (I literally have no idea what he was talking about). Meanwhile, my eyes are slowly glazing over. I have to start telling myself ot pay attention, but then I'm only paying attention to me telling myself to pay attention. I really did at the time want to know the answer to my question. I have to really really want to know the answer to a question to ask one at the end of the day. But I can tell you, it wasn't worth it. Especially since that guy is not evaluating me in any way shape or form. I could have asked my aunt later, she's a Rheumatologist. That would have been more simple. And I could just tell her straight to her face when I no longer cared about the answer.
Five second answers, that is waht I need. That's about all the time I can spare anymore.
Mostly, I can't win for losing anymore. You can't make me happy. One minute I'm bored out of my mind, sitting and doing nothing, but then the second work appears I'm hoping I don't have to do it.
My poor friends who aren't in medical school but are reading this. You must be terrified of going to the doctor after you read my posts. Don't worry, not everyone is as jaded and cynical as I am. And, when I'm with patients I'm fantastic, they all love me, and I find the answers, so don't worry. But medical school is this annoying game that I am not good at, because I don't have the attention span to follow the rules. If you give me the afternoon off I'm going to take it. I'm not going to try and find myself extra work to do around the hospital. If the choice is between seeing another patient or going home, I'll probably go home. Does this make me a bad student? I sure hope not.
I've found that there are a group of us like me. Students who don't play the game, because we don't have teh energy. Sometimes we worry that we aren't going to be good doctors because we don't play thet game. But friends, I really think we are going to be okay. Because when it comes down to it, I don't need to be the leading expert in any field. I don't need to be a super star. There is nothing at the end of the road I need to compete for. All I want is to be a doctor, and to do that I just need enough knowledge to either know the answers or know where to find the answers. I can do that. And, I've got great people skills, so I know patients will want to come see me. Right? I'm going to keep telling myself that.
Why do I want to be a doctor? Sometimes I don't remember. And people I'm sure often wonder why I want to be a doctor when I seem to lack any interest or enthusiasm in what I do. But the truth of it is, I kinda know what it is I want to do, and that interests me, and I know I can do it without having to be a douchebag about it. I'm not willing to fake interst in things I'm not interested in. But unfortunately, I need to learn how to.
Usually I'm all about the journey, but in this case, I just want to get to the end point. I want to be a doctor. I don't want to answer to a bunch of people. I don't want to have to pretend to be excited about things. I don't want to have to work hard just at maintaining a front. I want to do my work, help my patients, and go about my life. I don't want to be graded and evaluated against my peers. I just want to be a freaking doctor already! Gah.
Anyway, to all of you out there who really are interested in everything, good for you. But could you tone it down a little for those of us who are struggling to stay awake and get through the work they already have to do? And for those of you like me, who really couldn't care less, hang in there. We're all going to be good doctors one day. And to the gunners: bring it down a level, no one likes a douche

"it was a really good learning experience" is code for "my life sucked"

We medical students cannot just say that things are bad. So we've found new code words for expressing our distaste in things. WE'll talk about the hellishness of a rotation and instead of just being able to end it with that, we always have to add "well, I mean it was a good learning experience. I learned a lot." If one more person says that to me I'm going to kick their ass. Because I know! I know that means they hated every second of it, but for some reason we have to put a happy face on everything and pretend we love stuff that we dont! WHY?! It makes no sense! Is it just that we don't want to show any kind of weakness? Or that we are worried by saying we didnt like something we are going to get a bad evaluation, someone is going to think we are uninterested? Are we just trying to be more PC? I do not know. All I know is that I do it too. No one finishes a crappy rotation or class story without saying "well at least it was a good learning experience."
What does that even mean? I learned the self control not to kill myself or others? That's what it means to me. I learned how hellish life can continue to be. I learned that I hate certain parts of medicine. I learned that everyone is more interested in medicine than I am. GAH!
Why can't I just say "hey, this place sucked, and the experience sucked, and I hated it all, and I don't care if there was a good learning experience portion of it, I'm just going to talk about how much it sucked?" I mean, I know people should look on the bright side of things, glass half full and whatnot. But sometimes it just gets ridiculous.
I really have nothing more to say on this, except that I feel like a bad person if I don't end everything with "at least it was a good learning experience." But when you hear someone say that, run the other way from whatever they were doing. It's like when a guy asks someone if a girl is pretty and they say she "has a great personality." Code blue code blue! Run the other way.

Boards Post Traumatic Stress Disorder. It is real

Many people probably think I'm just making excuses for the way I feel about test taking these days, and no one wants to hear me talk about failing the boards one more time. But the fact of the matter is, it has permanently and horribly affected my life. I can't just get over it, like people seem to think I can. And in talking to other students who have also failed the boards, it seems to be a pretty common theme.
We have been through a traumatic event. We may not have been in 'Nam, or in Iraq. We may not have been brutality beaten or held hostage (at least, not literally). We may not have been in a natural disaster and almost lost our lives. We may not have been in a plane crash or been witness to a murder. But in our own way, we have suffered a trauma that isn't likely to leave our minds any time soon.
The boards are built up to be the end all be all of tests. Nothing in life matters quite as much as your board scores. They determine your entire future, your ability to get a good residency, fellowship, attending position. You will forever be judged on your board scores. And maybe none of htat is really true, but by the beginning of second year that is for sure what you think. You spend all of your time studying, worrying, stressing, crying, and then studying some more. the atmosphere during boards prep time is the worst time you'll ever have in your life (at least, I have to hope that is the worst experience I will ever have). And then the dreaded day comes when your scores come in, and you find out you failed.
The world really does feel like it is ending. You see all your hopes and dreams for the future fade off into the distance. All of a sudden all you can see is this failure, it defines you, it has ruined you, it means everything to you. And no one who hasn't failed the boards can truly understand what that means. They think they can, and they can be supportive of you, but when you've failed teh boards, you have lost a piece of your life. It is a dark, dark day. It shouldn't matter as much as it does, but sadly it does.
A friend of mine who also failed the boards said she went through the five stages of grief, and it is totally true. It is just like any other tragic moemnt in a person's life, except that it shouldn't matter so much. So when I tell people that I have PTSD from it, they laugh and tell me to cut it out. But they don't understand that I do wake up in the middle of the night freaking out about having failed. I do dwell on it and what it means for my future. I dread being denied residencies beause of this failure. I feel like it completely defines me. And the worst part is, it has taken all of my limited test taking confidence and killed it.
So now, when it is test time, I fall into a horrible depression. I can't get out of bed. I snap at everyone. I worry about failing. I can't focus long enough to study. I dont want to study. I'd rather stare off into space than get out my book. I start to cry, my stomach ties up in knots, and all I can think about is how I failed the boards and will never again be able to take a test. I try to tell myself that I will pass the rest of these tests, that if I study hard enough I'll be fine, that this time around I'll be prepared for whatever test is coming, but the week before the test the same thing happens: I realize I haven't spent enough time studying. I start to stress about how I shold be studying more. I try to study but become distracted by anything and everything. I feel a deep sense of dispair, and worst off, I don't care about anything. I'm so busy being stressed and anxious and depressed about the test that I have no energy left to study. So I stay in bed all day. I watch television. I stare at the ceiling. I take naps. I write blogs. I do not study. I do nto do anything productive. Because I tell myself I don't have time to go to the gym because I have to study, or I don't have time to clean or cook because I have to study, but then when I go to study, I just can't do it. And for some reason I never say I can't lie in bed all day because I have to study.
Then test time comes around and it is basically a self fulfilling prophecy. I don't do well on the tests, because I can't get myself to study. I have lucked out thus far and not failed another test, but maybe it is just a matter of time. Will I ever be able to get over this? Is it something that can even be fixed? I have to hope that eventually I will get over this and be able to study again, because the test taking is not anywhere near over. That all being said, I should probably go back to studying for my test next week...

Another example of how I am not a good medical student

I haven't blogged in awhile because I've been so busy with third year, which for all of you struggling first and second years out there, third year is awesome. I'm finally starting to feel a purpose towards this crazy life I chose, and am reminded of why I wanted to do this in the first place. Third year has given me hope that I did not make a mistake and that I do, in fact, want to be a doctor, and that I am, in fact, fully capable of being a good physician. Not to toot my own horn or anything but I am an excellent communicator, patients and other staff love me, and I'm a hard worker, so eventually I am going to be a good doctor, as soon as I figure out all this medical stuff. And I'm starting to see that that will come in it's own time. It was great when a doctor told me that the purpose of third year is not to learn everything about medicine, but to learn how to learn and how to practice as a doctor. The learning everything comes slowly over time. That is nice to know.
So, that's the good news about third year. I've figured out a couple of secrets to help me get through the rest of the year. Unfortunately, all of these secrets make me feel like a horrible slacker, and makes me worried about my future in medicine if already I'm finding all these shortcuts for life. However, I have also decided that when I want something, I'm willing to work hard for it, and I don't see the point in busting my ass for something that isn't going to make a huge impact in my life.
For example: I have pretty much decided that I'm either going to do internal medicine or pediatrics. Unless my neurology rotation is just the greatest thing since sliced bread, I don't really think any of the other stuff holds any interest for me. That has lead to me checking out completely in my rotations, which is bad. I am currently in my OB rotation, and I've realized that OB is just not for me. So I'm not going to go into it. However, if I were a good medical student like all the others, I'd still work my ass off for an amazing grade or whatnot. I am not like the other students. I have realized that I am not going to honor or high pass this rotation, and if I just do well enough, I am going to pass. So, instead of working my ass off to just pass, I've decided to just pass. That means showing up on time, being nice to my patients, doing my work, leaving, and studying for the test. It does not involve getting to work early, trying to overly impress people, and going above and beyond. Is that bad?
I think it is a little bad, because now my attendings can tell I have no interest in OB, and they probably think I'm a horrible medical student, and that really isn't good. But on the other hand, it is helping me stay sane in this crazy world. Saving up my energy for my rotations that are going to count for my future. Right? I sure hope so. Otherwise I'm just a bad student, and does that translate into being a bad doctor? I sure hope not.
The things I've done, that I'm pretty sure no other medical student has done in the history of medical school. Okay probably not that big a deal, but still:
1) I take naps. Why not? You know the saying "eat when you have a chance to eat, sit when you have a chance to sit, pee when you have a chance to pee?" I take that a step further and nap when I get a chance to nap. There is a call room for students on this rotation, and sometimes I have absolutely nothing to do, and I can't stand the thought of studying anymore, so I take a little nap. Apparently that is horrifying to some of my classmates. I think it is just good thinking.
2) I leave when I have a chance to leave. I am not one of those "are you sure?Maybe I should stick around," types of students. If the attending says there is nothing going on and I have the option of just sitting around waiting for something to maybe happen or leaving now, I'm going to leave. And if there has been nothing going on for hours, I'm going to ask if I can leave. It's just one of those things. So yes, I've left the hospital on a weekday at noon before, because someone said I could. And at 430 I've asked if I can go home to study or whatever if I haven't done anything since noon. And I don't think that is going to affect my evaluation enough for me to really worry about it.
3) Rotations where high pass is determined by a test grade automatically means I'm just going to pass. Therefore, I am not going to put too much effort into it. I cannot do well on tests. I have anxiety, I don't study enough, I have no self esteem. It's just a thing I've gotten used to. So while I believe if I study hard I can pass the test, I know that for most of these rotations I am not going to do that well. So what does it matter if I pass with a 70.1 or a 89.9? It doesn't, especially since all they see is pass. So I'm not going to kill myself to turn in stellar work for our busy work that we are given. I'm not going to try and be the best student ever. I'm going to do what it takes to get through, learn what I can in the meantime, and try to hold on to my sanity.
4) I plan things during rotation time so I can get out of rotations. Especially in the ones I'm not passionate about. Sure, I'll come have a meeting on campus at 3pm! That works just perfectly, that gets me out of clinic for awhile. It's for school right? Oh I have a doctor's appointment...oh yeah...hmmm...dont' feel bad about it. Granted, I don't do this every day, but I probably do it more often than I should.
5) I am devious. Recently I have started playing attendings against each other. Not really in the horrible way that sounds. More in the "oh Dr. so and so said I should work with them today..." and then turning around and being like "oh I need to get back to work with the other doctor" and then leaving. Or hiding out to study. They don't seem to notice. It's pretty awesome. Or going to preceptor in the morning, coming home and napping before going back to my rotation. Yep, that is me.
Hopefully none of my attendings will ever read this blog, or I will be busted big time. But honestly, I don't think any of this is going to have a negative effect on my ability to treat patients, because when I'm with a patient I give my best, I give them everything. I'm passionate to work with people, I want to help them as best as I can, I like to be there for them and be the one to take care of them. I just don't put up with a lot of bullshit, and I can't pretend to be something I'm not. Which is a gunner. So, yeah, maybe that makes me a bad student, but I don't hear my patients complaining. Maybe it's because I leave before I can hear them. hmmmm....