Crush

As much as I seriously hate to admit this, I think Kate Middleton is my new idol. If I could dress like her every day I would. I feel like that sums up my style in a nutshell...classic, classy, put-together, not too trendy or flashy, delicate, perfectly tailored...I could seriously go on and on. Unfortunately I will be wearing mostly scrubs in my day-to-day life for the forseeable future and I can't afford all the fancy clothes on a medical student's salary, but for now I have a big girl crush. I can't help it...can you blame me??

Vacay

Well, it's Christmas vacation...finally! I was so stressed out about my paper that I haven't been excited about it at all. Now after writing 10 pages and using 51 sources in the end, I can sort of relax. Tomorrow I have to drive for another interview, so really Wednesday is when I can let it ALL go and just focus on Christmas and New Year's.

Last rant about my paper, I promise: I found out that the only other girl who is doing this elective right now (and we're the first ones to take it) only used 3 sources for her paper and only had to meet with him 1 time during her 4 week elective (I had to meet with him 3 times in person during my 3 weeks, costing me an additional $500+ in airfare flying cross country to do that). NOT happy, at all. But I can't say anything about it because my professor is a "big guy" in a residency program that will be high on my list...I can't be a complainer before I match there or else I might not match at all!

Now I am going to try to embrace the Christmas season, put school behind me for a few days, and be glad to spend time with my extended family. We'll only be missing my uncle, who is 6 months into his 1 year tour of Afghanistan...come home safe!!

Merry Christmas Season!

Pressure

So many things to update, so little time!

1. My residency interview last week TOTALLY threw me for a loop. I thought for sure my first choice program would be at my home-base, but this last interview was AMAZING. The town is exactly the kind of place I always pictured myself living, where I feel like I really belong; the program has all kinds of cool features (tracks: during 2nd and 3rd year, you get 16 hours "off" a month to pursue particular interests, like toxicology or medical education (totally my thing); scribes: they have a pre-med follow you around and document everything you do while on shift, meaning no documenting/no dictating/way less hassle! This is amazing- documentation is the bane of every doctor's existance); it is close to some of my extended family, etc. It is a program that I would truly brag about being accepted at, and that is very attractive to me. Only downside: I feel that I fit in better with the residents here at home. Not that I don't get along with these other residents; they are very nice. I think it's that 3/4 of them are married and lots have families- they are just in a different place in their lives than I am currently. If I am going to pick up and move far away from everyone I know, I want people who have time to hang out with me outside work! I know that is selfish, but it IS three years of my life here! I am totally torn and very anxious for my upcoming interviews to throw more wrenches in the process.

2. This "reading elective" turned 10 page paper took a turn for the worse 2 days ago. I thought I could write a 10 pager with probably 10-15 sources (journal articles). Oh no. My mentor said he anticipated that I would need to cite 50-60 and that I had to include all of the trials that had been published recently. Whoa. So I did a literature search...1530 articles in the last 10 years only. So what choice did I have? I skimmed through all of their titles, throwing out ones that were definitely not related...that got me down to 620. Then I had to start looking closer at their abstracts (short summaries) to decide if they were worth my time...down to 200. I managed to do all of that yesterday (powered through!). 200 is still WAY too many, so I whimped out and contacted my mentor, telling him that it wasn't realistic to read all of those PLUS write my paper PLUS fly across the country and interview by next Friday, so I had to narrow my paper topic a bit. Luckily he agreed, but now I have to go through the 200 articles I have pulled and throw a bunch more out. Basically I am spending all day/night today doing that. So that means I have to read SO much tomorrow, write a TON on Sunday, and have a rough draft to give to him on Monday (the day I fly out of town til after Christmas). This is SERIOUSLY stressing me out! Luckily, D went out of town so I can hole up in the apartment alone and just pound out the work without any distractions.

3. I only have 5 months and 3 days left until graduation. This is I-N-S-A-N-E. I am not ready for this. I am not ready to leave school behind forever. I am more nostalgic than ever for college. Even though residency is a lot like school still (presentations and tests and assigned reading), I am going to miss school dearly. I am sure once I'm done with residency I'll start working on my BA in Philosophy (something I have always wanted to go back and do). I'll be in school forever!

That's all for now, I need to get back to sorting through articles. The pressure is on in so many ways right now! And I wonder why I have no time for a personal life?!? More on that later...

Chugging Along

Well, I guess a month has passed. How is it that when I have more time outside of work/school, I post less? Weird.

My radiology rotation came and went, interrupted by 3 interviews and Thanksgiving. The rotation was easy hours (8-4 M-F), no responsibilities...basically I sat and looked over the radiologist's shoulder all day watching them read films. They were all very nice and tried to involve me, but not much I can do as a student. I am glad I had it as a rotation though, nice and easy and hopefully I learned something.

Now comes some drama. Originally I had the next 5 weeks off for interviews and Christmas. However, I decided last minute to sign up for a "reading elective" (aka 1 hour of reading a day, 1-2 meetings with my mentor = 4 weeks of credit. Sweet!) with an attending at my current first choice EM program, both to learn something as well as hopefully impress them. I laid it out very clearly in my first email that I would not be around very much due to interviews and that if they could be flexible with me, I would love to do this elective. He agreed. I signed up. Then I came to find out that I am expected to meet in person with him at least once a week, read/work about 45 hours/week, and write a 10 page paper. What?!?!?!? I am SO upset about this, basically because this is NOT what I signed up for and if I had known that, I would have asked him to do an informal "reading list/discussion" with me for no credit. However, now that I am signed up, I can't very well back out just because it is a little more work. Alas, I have to spend the next 3 weeks juggling interviews, travel, and all of this work. There goes my vacation!

Interviews are getting to me. They are just fine to go on (although airports and hotels get tiring), but I wish I were getting more offers. After 29 applications, I have gotten 8 interviews, 9 rejections, and have not heard from 13. That is more flat out rejections than I was expecting, and at this point if I haven't heard anything I am not planning on hearing anything. I wanted to go on at least 12 interviews, so this is a bit of a let down. My last ditch effort is to email programs and basically beg for an interview. We'll see how that goes. Frustrating! I still know that everything will work out, but I am getting tired of this process.

Lighter

On a lighter note: a patient's friend asked me if I was Miss Arizona when I walked into the room the other day. Thought it was pretty funny. Vets always say the darndest things.

Nail Biter

Patient of the day: 19 month old who was lethargic. She had a lot of other medical problems and had had an endoscopy yesterday. Since then she had been lethargic and vomiting brown. In the ED, she looked pretty bad...very lethargic, kind of hypotonic, pale. She got a LOT worse pretty quickly. PICU came down and we had probably 7-8 people around the bed for this one little girl. Her glucose finally got checked (somehow this order from when she first got into the ED had been overlooked) and it was 1. ONE! Glucose should be around 100, and below 40 is SCARY low. Hers was ONE. I have never seen anything that low, and I have no idea how she wasn't having seizures or how she wasn't dead yet. She was so dehydrated that they couldn't get an IV in, so they had to put an interosseous line in (basically punching a hole in her leg bone to run fluids directly into her bone marrow). She got some glucose which put her blood sugar at 187 and started looking better. She kept oscillating back and forth from looking a bit better to being really lethargic again. We never intubated her and she made it out of the ED to the PICU, but it was a REALLY scary situation. I hope she will end up doing ok. Lesson learned: always check a glucose on anyone with altered mental status...low glucose really can happen even when you're not expecting it!

The Other Shoe

I should have been waiting for the other shoe to drop after a "fun" trauma. And boy did it drop today.

First patient: 14yo boy in a car accident. Intubated at the scene. Arrives in a c-collar (neck brace) thrashing around because he needs more meds to sedate him/paralyze him/take away his pain. It takes at least 15 minutes to get an IV in him to give him any meds. I felt for this kid the entire way. He ended up having a pretty significant bleed in his head and a number of other things but will hopefully do ok. Naturally it didn't stop there...

Second patient: 20yo man ejected from his car. Intubated at the scene. Helicoptered in. Went into cardiac arrest literally while walking in the door of the ED from the helicopter. His pulse came back for a while, then went away again. About 45 minutes of pushing meds, doing CPR, putting in 2 chest tubes, 2 femoral lines, and finally cracking open his chest and beating his heart for him, he was pronounced dead. If that wasn't bad enough, it was at that point turned into what I'll call a "teaching opportunity" for all the residents, students, and anyone else who wanted to to put their hands in his chest, learn the anatomy, etc. I politely declined to participate, but in reality I am immensely offended that this took place. He did not consent for his body to be donated to science, we were not doing anything to try to save him at that point, and while I understand some people would argue that if he died he might as well be "useful" to teach and learn on I do not agree. I heard stories about this at the beginning of 3rd year (ex. practicing intubating on a patient who had just died, etc.), and always thought "oh that would never happen and I would just say no anyways". Well, it happened today, and I did say no (which I'm proud of), but I'm afraid that it might come back to bite me ("she passed up a great learning opportunity", "she doesn't care about becoming a great doctor", etc.). Even if it does, I'm sticking to my ground and respecting this incredibly unfortunate young kid who died today. I hope everyone will be reasonable and respect my decision.

Didn't really want to tell this story, but it's the first time I've had a patient go from "alive" (with a pulse) to dead right in front of me. It was especially hard with it being a young guy. He was married (wedding band). Just heartbreaking. Definitely shed just one tear for him in the trauma bay before having to pick up and go back to my other patients with a headache and abdominal pain. Puts everything in perspective. Hard day, but I guess if I can't take it I shouldn't be doing this. No choice but to pick up and carry on.

Excitement

The other day I was already a half-hour over when my shift was supposed to end, just trying to wrap up a few things on my patients, when I heard this over the doc's pager phone system: "Level 1 Trauma alert, LifeFlight ETA 45 min, bear mauling".

!!!!!!!!!!!!!!!!!

Um, hello. Of course I'm staying for that! LifeFlight is the helicopter service here (I get to do a flight shift next week, so excited/scared!). I heard the patch (the conversation on the phone between the doc in the ED and the paramedic on the chopper) shortly afterwards and then stayed for the trauma. This guy was SO lucky! He was bow hunting (quite popular here), where they climb way up in a tree and just sit and wait to hunt something. So he was up there minding his own business when a bear cub started climbing up the tree! He yelled real loud to scare the cub off, which worked, but mama bear was PISSED. She came up the tree, dragged him out of it and then dragged him another 20 feet before being scared off (not sure by what). He didn't have any broken bones (at least as far as I know)! All he had was soft tissue injury where she bit him and some lacerations to his face. Like I said, SO lucky. Pretty cool to see!

In other news, I got two interview offers the other day...phew! I was starting to wonder if my application didn't get sent or something! So that brings my total to 4 so far (2 where I rotated at and 2 others) out of my 29 apps. Most ED programs wait until after November 1st to offer interviews (when my application is complete with my Dean's Letter), so I should have more to come, but I was still starting to worry! After next week my year is essentially over in terms of difficult classes (until April that is...), so all I need to do after that is interview and pick a program. Easier said than done!!

One down...

Well, one week down. It went REALLY fast, I think because I didn't really have to do much of anything. No real ED shifts. I had orientation, a day of lectures, a day of "nursing skills" (mostly IV's, 1 NG tube, no Foley's), a day of simulations, and a "fast track" day (suturing, back pain, a guy who maced himself- hilarious). Fast track is where they put people who have very straightforward problems and who should be in-and-out. And then I had this whole weekend off. So my first real shift is Monday. Weird! It was nice to have a week to settle in, but I'm kind of bored, I have to admit. This weekend included watching a TON of TV shows online, reading books (finished Mansfield Park, started The Metamorphosis, looking foward to The Jungle Books soon), calling friends, and basically just bumming around. The internet blocks Netflix, so I can't watch any movies, and there aren't any movie theatres within walking distance, so that's out. Not sure what I'm going to do for the next three weekends here! Hopefully one will be spent with my extended fam if I can find a way to get up there!

I walked around the town a bit this weekend. The weather was SO nice (70 degrees, clear skies), and the town is really cute. Tons of hills, tiny streets, trees, grass, old houses, Halloween/autumn decorations, etc. It definitely brought me back to college (yet again) and I am VERY nostalgic for my college town...still! I thought that feeling would go away but nope, I still miss it a ton. NO idea why, college was not the greatest 4 years of my life (not the worst, but not the best). However, I am missing my actual college buildings, the dorms, certain restaurants, shops, drives I used to go on, parks I used to run at, farmland...I could go on and on. What does all of this mean? I have no idea. I have lots of time to mull it over and maybe figure it out, though!

Even though I just got here, I am anxious to get home so I can do some things. For example- cook, decorate, re-re-discover things to do in the city, reconnect with some friends I haven't had a ton of time to hang out with recently, spend time with my sister and family (this may be the last year we are living in the same city, depending on where I go for residency). I could do a lot of those things here if I was going to be here longer than 3 more weeks, but it just doesn't feel like home (for good reasons, I think) and so everything I do is a bit temporary. I'm having a good time but I want to feel at home!

No good patient stories from this last week...the only kind of funny one was the 50 year old guy that accidentally maced himself in the face while cleaning his garage. Not sure how that happens, but I guess it did. He was laughing about it so I don't feel so bad laughing about it too. Hopefully I'll get at least one good patient in the next week I can talk about!

College?

I am basically back in college...and I LOVE it! Here are some of the similarities:

1. Dorm living in an OLD building, shared bathrooms and all (yup, flip flops in the shower).
2. Cold weather and changing leaves.
3. No car.
4. Cafeteria food, snacks in my room.
5. SMALL town (ok, this is WAY smaller than my college town, but still!)
6. Listening to John Mayer and Coldplay (my iTunes hasn't been updated in a while and the internet blocks Pandora...not that I get internet in my room anyways!!)
7. A twin bed with a bad mattress...complete with my actual sheets from college!
8. Coin operated laundry in a scary basement.
9. Lysoling even the doors in my new room with my mom.
10. Being far from home.

...all that's missing is my roomie!!

I know all of that may sound terrible, but I am seriously LOVING it. I quite literally feel like I'm back in college, with all the freedom, excitement, and irresponsibility that go along with it. I feel like I'm starting a new slate, and that is always exciting. I can't wait to wander around this little town, have the leaves really change color for me, and spend some quality time with myself. So like we said back in high school:

yay college

Autumn

I have a bit of insomnia tonight...so what do I do? Counting sheep is for sissies; I'll blog!

I took my test for my rotation today. Not too bad I don't think, I hope I did well! It is VERY sad that this rotation is coming to an end. I have had a great time, and I will miss all the people very much. I guess we'll see if I match here come March! I am currently packing to go away for a month on my next rotation- another month of fun in the ED! I am excited but pretty nervous, I hope I don't look like an idiot. Hopefully with one rotation under my belt I'll look like a pro...yea.

I have gotten the fall bug...I am very much looking forward to going on this rotation to a place that actually HAS a fall, with leaves and crisp cool air. For some reason lately I have been missing Nebraska...I know, what?!? I think I just miss the fall, since it is still >100 degrees here with no end in sight. Summer I love ya, but I'm ready for just a bit of brisk-ness in the air.

I feel pretty happy at this time of year. Maybe because it's when school usually starts and, let's face it, I love school. Maybe it's because I get to eat lots of filling, comforting food (yikes for my waistline). Maybe because it's a time when everyone wants to sit at home and be with lots of people, kind of like a teaser for Christmas (my FAVORITE season of all). I just feel full of hope that things will be good and something big will happen. No idea what, but I can feel it. Naturally it also makes me feel a little lonely, but I'm trying to focus on the positive here!

So here's to autumn (because that just sounds so much more sophisticated and grown-up)...warm drinks, squash, crunchy leaves, sweaters, listening to great music while reminiscing by the fire, and the sweet anticipation of Christmas.

Goals

First something exciting: I forgot to say this, but I found out that I HONORED my surgery clerkship! This is incredible, I didn't think it was going to happen but I am so proud that it did. I also got a high pass on OB/Gyn (I was *this* close to getting honors...dang!). Pretty exciting to close out the year with a bang!

Next, I am making some life goals. Now that I am on a clerkship that (I feel) gives me a pretty good idea of what my life will be like the next few years, I have the urge to try to develop the rest of my life around my schedule...what better time to start than now!

-Like I said before, I am trying to cook more. This doesn't amount to actually cooking that much because all the stuff I make can feed like 6 people so I end up eating it for days (which can get boring, but that's a whole different story). I made a pretty good "chili cornbread pie" the other day...next time I think I'll use a different kind of cheese and milk in the cornbread mix instead of water, but overall satisfying, healthy (it was from Cooking Light), and EASY (hey, I did it!).

-Along with cooking I am trying to eat healthier. I always did a fair job I think, but definite room for improvement. This is tricky when I don't eat at all the whole time I am at work usually (maybe a granola bar and a glass of water...maybe) and I get home at strange hours...can't really cook up a whole meal when D is sleeping right next to the kitchen! However, I need to get used to it, so we'll see how it goes. Today I joined the MyPlate website that allows you to track what you're eating. I don't really believe in food diaries (even I'm not that OCD-esque), but I think doing it for a short period of time can be useful to really see what I'm eating and what kinds of things I need to eat more of. The website is really cool and SUPER user friendly...I highly recommend it (but hey it's only the first day, what do I know).

-Too many goals for one time, but I am also trying to workout more. This has always been the weakest part for me, so I am starting SUPER slow...just doing my little ghetto elliptical machine for 30 minutes as often as I can (probably amounts to 3 times a week right now). Again, this can get tricky because I can't do that at 4am with a roommate, but I'm doing my best! I'm trying to stay positive about this measley little bit of exercise because at least it's more than what I was doing before. Not super, but it's a start.

-My Mid-Year Resolution is to take my vitamins. My New Years Resolution this year was to floss, and I seriously am still flossing basically every night (at least 5 times a week on average), so I decided to do resolutions more often. I think the key is to be specific, so right now it's vitamins. I even bought a pill box to remind me. Going pretty well so far. It's been over a month since I made the resolution, and I've probably averaged 4 times a week. Not great, but better than I was doing before so I'll take it.

-I have been reading more non-school stuff than I have in the last year, which is SO nice. I live and breathe reading, so it is nice to have time for that again! Currently reading Mansfield Park. 500 pages, which normally would take me like a weekend if I really sat down to it, but I've been reading it a little over a month. I got a good chunk into it on the drive back from CA, and have been plugging along pretty steadily since then. Next up: The Jungle Books I think!

Kind of a long post, but really more for me to remain accountable and remember that I am trying to get it together. A friend of mine from school and I had a long talk the other day about how we feel like the last 3.5 years have LITERALLY been all about medicine, and how we feel like we are so much more than that and how frustrating it is to feel so limited. The light is at the end of the tunnel when we can hopefully break free, but what better time to start than now!

Better

Well, I made it through last week. Clearly that was tough! But I got both of my tests taken, my applications submitted (on the first day I could, thank you very much! That's a record for me), and some fun times in CA with friends and family. Thanks everyone for showing me that California is tolerable :)

Naturally, my horrible week just couldn't stop with my test on Friday...our family dog died on Sunday while we were all out of town. I am glad that he is not suffering anymore, but I wish he didn't die alone. Love you Dukey!

After my vacation, I have started back doing what I L-O-V-E: emergency medicine. I had my first shift yesterday, and all it did was confirm that this is the right choice for me. I have a LOT to learn and a lot of areas to improve on, but I am totally in love. It is fast-paced, busy, focused, fun, and the sense of camaraderie is unparalleled. Before, during, and after my breakdown last week, I was seriously questioning what the heck I was doing...I didn't want to do this anymore. Forget med school, forget being a doctor, I was just done. My sense of purpose is renewed this week :) And that is a relief!

One of the best parts of this rotation is the schedule...15 8-hour shifts in 4 weeks. That sounds like a normal amount of work, but to me that spells FREEDOM. I have 15 days where I don't have to work??? Are you serious? Sure, nights and weekends aren't always free, but give me a DAY off anyday so I can get things done and I'm a happy camper. So here's to getting things going in the rest of my life! Step one: cook more! Yay!

Slime

I am having a bad day. And it's a big, important day. So I need to vent.

As I am sitting here filling out my residency application, I am forced to reflect on all the things I have done in the past 8 years and basically talk myself up huge. Reading these paragraphs about my accomplishments should make me feel awesome..."look how much I've done and how far I've come!".

I don't feel that way.

There have been only a handful of times in my life where I have felt this inadequate. Unfortunately, all but one of those have occurred in the last 2 years. I feel like I have done nothing. I have no accomplishments. I have gotten through med school, but that's about all I can say. I don't excel at anything. I do mediocre on tests. I get fair evaluations from difficult clerkships. I have no research. I am not a perpetually happy, nice person. I have nothing amazing outside of school, and now I have nothing amazing inside of school. Why did I get in to med school? Why should I get into residency? Why should I be a doctor? Why am I bothering?

And now I have to go write a personal statement talking about how awesome I am and why I deserve to go to a particular residency program.

What I really want to say is:

This is bullshit. I'm nothing special. Don't bother.

Update

They graded my surgery shelf and I passed (it wasn't even my worst shelf grade!)...I'm assuming I didn't fail the clinical portion of OB/Gyn or Surgery (I don't have those evaluations back yet), so as far as I'm concerned, I feel comfortable now saying I'M A FOURTH YEAR! This is an exhilarating feeling, which is nice 2 days before my boards. I am so relieved to have that out of the way, and I'll feel even better after I have the full official grades (shelf + clinical).

I have decided that my "last first day of school" will be Tuesday the 7th. Since these last few weeks were just studying, they were like my "summer", and since at that point I'll know I passed all of my third year, I can officially be a 4th year! I know, kind of a stretch, but I have REALLY been wanting a "last first day of school" picture since I mentioned it last time, and I am determined to have it. Since most people in my class took the first month of 4th year and studied, it was kind of like their summer, so now it's mine too (just a month later!). Now hopefully I'll remember to have D take my picture by the door!!

P.S. Still overwhelmed about my test and my application. Test part 1 on Monday, application due Wednesday, test part 2 on Friday...THEN a nice little vacation weekend with the fam. If I don't have an ulcer by the end of this week it'll be a miracle...what was I thinking?!?

Pause

Reading over my last post, most of those things still ring true. Except now I am even more overwhelmed. Right now just focusing on my multiple choice exam and my residency application. My sleep cycle is SO crazy (go to bed at 3am, wake up at noon). I am studying every day; it is getting to be a LOT of information. I'm not eating all that well. All I do is drive/study/drive/watch tv/sleep. And I have made zero progress on my application (sort of by choice...I can't think about that and try to study at the same time- it is too good of a distractor). I'm exhausted, cranky, hungry, and feeling inadequate. Oh, for it to be 2 weeks from now when it will all be over!!

Two things that are different:
1. The last thing on my list...not so let down. Too busy to really think about it right now, and maybe that has something to do with why I'm not let down, but whatever. Just takin it slow. Super slow. Maybe that's all I can handle right now.
2. Update about my surgery shelf grade: the NBME (National Board of Medical Examiners), who administers and grades the test, never graded mine. Last I hear, my answer sheet got left in my test booklet which was subsequently stored in a warehouse. They have sent for my test book and will grade my exam and notify my school by Tuesday. Slight panic attack. As long as they find it and grade it and it's actually mine, it'll be fine.

Totally different note: even though I am 6 weeks in, I just realized this is my last year of school. EVER. This is huge for someone who has been in school continuously for going on 22 years. I'm kind of sad that I didn't realize it at the time and take a "last first day of school" picture or something. Kind of forgot about it when I didn't get a summer break. Anyways, this makes me a little sad and scared...what will I do in the adult world? Because I am more and more convinced that a lot of what med school does is push back the real world (if you go straight from college). I'm excited for it, but I like school...I've always been good at school...school is my safe place (not so much since med school, but that's a different story...). Time to get on with the rest of the things I hope and dream for my life. So here's to a great last year...I know it'll go too quick. It's already almost September...sheesh.

Whoa.

Overwhelmed. That's all there is to it. Here's why.

1. My mouth still hurts. It is not healing as fast as I thought it would, and I'm crabby about it.

2. Studying for part 2 of my boards. Multiple choice test on August 30th, practical exam on September 3rd. I need to do well on the multiple choice, as Emergency Medicine residencies put a lot of stock in that exam. However, I have no motivation to study and find myself daydreaming...a LOT. This is stressing me out BIG time. And in true-to-myself fashion, I am ignoring it and pretending it will just go away. Typical.

3. My residency application is due September 1st. This is a big deal. Not only is it filling out the application (including a personal statement...ugh!), but it is getting letters of recommendation and, biggest problem of all, deciding what programs to apply to. If all I had to do was get the application ready and click "submit", I would not be that worried. But I need to narrow down the 120+ EM programs across the country to the 20-25 that I want to apply to. And I don't even know if 20-25 is the right number to apply to. This terrifies me, as all applications usually do. For college I didn't apply to enough programs, for med school I probably applied to too many...what the heck am I supposed to do now?? I know that I need to end up interviewing at and ranking 10+ programs, but how many do I need to apply to to ensure that I get at least 10 interviews? And how do I know what programs I am interested in? Clearly this is the biggest deal for me.

4. I still don't have my Surgery exam grade. I have my OB exam grade, and I did pretty well. Just waiting on the official overall grade (including my clinical grade) from OB. But Surgery...I am getting antsy.

5. I need to start getting things in order (flights, $$, paperwork, etc.) for my away rotation in October and my international rotation in February. I know those are farther away than the other things on my list, but unfortunately they still swirl around in my head.

6. Boys. Why do I have to get so excited every time only to end up feeling let down? That's all I have to say about that.

There's more...I'm sure of it. But that's enough for now. Back to studying and feeling slightly inadequate and in limbo. Blah.

Coasting

Time flies, even when you have a lot of it!

This last 3 weeks have been a really nice "break". Yes, I am still in school/work (Toxicology- poisionings, overdoses, snake bites...totally awesome), but the hours are CUSHY (9-2), I don't have to write notes or even see patients on my own (which I feel I'm getting out of practice with as a result!), and it is a TON of teaching. This is super nice because I need to start getting ready to study for the next parts of my boards, which I take at the end of August. The faculty are so great and they are all Emergency Medicine trained before doing Tox, so it is a good source of information for me.

Currently I am home in a lot of pain from a tooth procedure that has had a little complication. Nothing catastrophic, but it hurts and there's nothing anyone can do about it. I've been eating nothing but liquids/soup/mashed potatoes for about a week and I am so sick of it...with no end in sight due to the little problem that happened yesterday. I'm hungry and cranky and I just want it to get better!

Still no word on the 2 tests I took a month ago. Hopefully in the next week or so I'll get my scores...I have gotten really good at waiting a looooong time for results! Still praying I passed, hoping I did well.

Not much else to say...livin is easy right now and I'm not being very productive but I need a break!

Phew!

Well, I did it. I am officially done with third year. Today was my first day as a 4th year (MSIV).

This is pretty incredible. This is the year that my medical education truly becomes MINE, and not what someone dictates for me. I have basically all electives this year, and I made my schedule in terms of when I do what. There have been some glitches in the system, but I think it is almost settled. It is crazy to think that now I will be learning some things that my classmates will not be learning and might possibly never know.

I started on Toxicology today- so drug overdoses, poison ingestions, insect/snake bites, etc. This is a great rotation for a future ER doc (like me!) because a lot of things that walk into the ER, particularly in Phoenix due to the snakes and scorpions, are tox problems. I hear this rotation has great teaching and is really interesting, so I am VERY excited for it. It is also very laid back, which doesn't hurt :)

Even though officially I am an MSIV, I am reluctant to actually call myself that because I don't yet know the results from my Surgery and OB shelves/rotations. I feel pretty confident that OB went just fine, but the Surgery test was BRUTAL and every one of my classmates felt like they failed, myself included. I'm sure we didn't all fail, and I'm just praying that I'm one of the ones that passed. Some people say that we find out 2 weeks after the test (which would be this coming Friday), but with other shelves it took 4-6 weeks. So I could be on my second rotation of 4th year before I finally feel like I have actually finished 3rd year. I'll just keep hoping and praying that I passed!!

Little Slip

Today, I am having a little bit of a breakdown. Just a little one. But I'm worried it could build into a monumental one. So I'm going to try to let it out before that happens...

I have 2.5 weeks left of surgery. So 2.5 weeks down. It is going just fine I think...not stellar but I don't hate it and I'm not getting yelled at every day, which is nice. However, at this point it is time for my mid-point evaluation. I asked my resident for an informal eval, and he said "Yea, you're doing fine. You show up, you see your patients, you seem interested". Now, this sounds fine, but for someone who has Honored the clinical part of every rotation, he said pretty bland things without a lot of enthusiasm, which translates (to me) to mean nothing too great. So I pressed him a little further, "Is there anything I can improve on? I do really well with negative feedback, I'm not going to go cry about it or anything". And his response? "No. I can't really think of anything you need to improve on". Again, unenthusiastic and completely unhelpful. I'm worried he's thinking terrible things he's not saying. But I tried to ask, right? I did my best to try to do better, and he has nothing concrete to give me. So I guess just keep doing what I'm doing? Since I asked, I had better not fail for not meeting expectations. I'm worried about it, but not too much because I don't know what else to do about it.

This also means that I have 2.5 weeks until my "double shelf" day...2 "Shelf" exams in one day (OB and surgery). This was a dumb idea from the beginning (I fully blame the administration for this one), and people are legitimately failing these exams due to them being on the same day. 2.5 weeks sounds like a long time to study, but when I'm working and/or exhausted most of the time, it's hard to study. And it is SOOOO much information! I don't want to fail these tests because I just don't want to have to take them again. I just want to pass! I think I will, but I don't want to be overconfident.

Lastly, I'm a little down and lost lately. Just feeling a little lonely and "stuck" and tired of being so focused on school. I need a little break and I'm not really going to get one. This is my first summer EVER without a break, and I think maybe I'm feeling it. I can relax more after Surgery is over, but (like I've said before), I'm kinda ready to get along with the rest of my life and be done with school. Less than 1 year left until graduation (333 days to be exact...and yes I just calculated that). I guess just keep pushing through. One step at a time...just get through these next 2.5 weeks, and then worry about the rest later.

Just keep swimming, just keep swimming...

Another End

I am finished with my OB rotation...W-O-W it went fast! The most frustrating/annoying/difficult thing about 3rd year is that just as soon as you start to feel comfortable on a rotation (you know where everything is, you get along with your residents, the attendings remember your name, you know what is expected of you and can stop worrying about doing something wrong and start actually thinking critically about the patients and their problems) you switch to a new one. And the cycle starts all over again. Naturally, that is what has just happened with OB.

I had a hard time on this rotation in the beginning, but it had gotten much better by the end. I still didn't feel as comfortable on the rotation and with the patients and the diagnoses that I was seeing as I had on some other rotations, but I was getting the hang of it. I am sad to leave this rotation as there were things about it I had come to really like. I actually liked the clinic part of this rotation; there were a couple of patients that I saw in the clinic multiple times and that was pretty cool.

I did not get my wish of doing things in the OR this past week...we had a really huge team (an attending, an intern, a 3rd year and a 4th year resident) and since they all take preference over me for doing procedures I didn't get to do ANYTHING. I literally only scrubbed in for 1 case all week. The others were all laparoscopic or robotic cases, and so there is really only room for 2 people to be scrubbed in and around the patient. It was disappointing. It was also a little annoying to be there from 5:30am-10pm some days where I literally did not do a single thing. On the other hand, the attending was SO fun to be in the OR with, and was really apologetic about me not getting to do anything, so I guess I'm not that upset.

Three day weekend (YAY!!) and then surgery on Tuesday. I didn't get a whole lot of practice on OB for my surgery tasks, but hopefully I'm ready!

Home Stretch

I have one week left on OB and then onto 5 weeks of surgery...after that and 1 week of b-o-r-i-n-g lectures I will be a 4th year!!

My last week of OB is on Gyn Surgery, so hysterectomies, ectopic removals, cancer resection, etc. Basically I have 6 weeks of surgery. I am alright with this, as long as I get to do SOMETHING in the OR. Even if it is just holding the suction thing and sucking away the smoke that the bovy makes (bovy= metal wand thing that burns/cauterizes vessels and burns through fat). If I am not doing anything I am SO bored and get really tired of standing there with noone saying anything and me not doing anything. Some of these gyn surgeries can go 6, 7, 8 hours or more if they are big cancer resections. That is a long time to stand, not touch anything (because I'm scrubbed in and sterile), not eat or pee or drink anything and not talk. So I am going to be aggressive about doing something, anything. Hopefully I can help stitch someone up at the end of the surgery. The surgeons have to like you and trust your skills for that to happen, so I need to really bust my butt and show off.

I can't believe 3rd year is almost over. This is probably the hardest year (as a whole) in med school. It was difficult, but I have had a GREAT time. The next hardest year will be my intern year after graduation. Interview season will be difficult, but as a whole 4th year should be really fun...easier schedules, no tests, way less pressure. It is hard to wrap my head around the fact that all these years of working hard at school are almost over. I am almost to the point where I will have a job that requires no additional work outside of work hours.

Lately I have been really looking forward to having a life outside of school. I really feel like I have been missing that for the last few years. Outside of school I have nothing; no house to really spruce up, no vacations to plan, no one to take care of, no real consistent hobbies. I think it is really sad that by the time this is all over, my 20's will be almost entirely over and all I will have to show for it is a career. Now don't get me wrong, that is a huge deal, and it will give me so many opportunities for the rest of my life. But I want more than a career. As soon as surgery is over (I know, another delay, but seriously it is NOT possible until after that 5 weeks is over) I am going to start doing things to round out my life. When I was in high school I was so proud of the fact that I was so well rounded. I have totally lost that and I need to get it back. More specific plans to come later.

In Brief

Um, it's been a while! Here's a summary:

Finished Neuro. Had a GREAT experience. Don't think I can do it as a career because neuro diseases are so devastating and usually there is no cure and in a lot of cases no great treatment. But that is hard for me to say. I really liked it.

Spring Break. Such a nice break.

Emergency Department (ED) rotation. Rocked. My. World. I loved every second of it from day one. The traumas, the routine people coming in (women miscarrying, asthma exacerbations, chest pain, cellulitis), my interactions with the residents, how much everyone really cared about the patients, how BUSY everything was, how quick decisions were made and how quick results were obtained, getting to DO things (stitches, pelvic exams, ultrasound, re-locating joints), etc. I could rave on and on about it.

Anesthesia rotation. It was alright. I learned a lot about physiology that I forgot, saw some cool surgeries, but talk about a lot of down time. Wow.

Started my OB rotation. Not stellar. I don't hate it, but I definitely don't love it. I have not really been getting that overwhelming feeling of awe when a baby is born that I was expecting to. And the rotation is hard...the residents and attendings are very critical and judging everything you do it feels like. Haven't had that in a while, so glad that is almost over. Very long hours...13 hour days at work at least, 30 hour calls once a week. Literally I get up at 4am, work 5am-6pm, get home at 6:30pm, go to bed at 8pm. Since I'm supposed to be studying everyday when I'm not at work, that really cuts down on the other things I can do (laundry, grocery shop, cook)!

Planning my 4th year is still an issue. Now that I've 98% decided on Emergency Medicine my schedule needs some tweaking. A work in progress.

So that's it in a nutshell. My life is consumed by school. This will continue until at least July 4th because after OB I go onto Surgery, where the hours are even worse and the attendings even harsher (or so I hear). Wish me luck!

Decisions, Decisions

I took a quiz online (from a university's med school website) to tell me what specialty I should pick for my career. It assigned a point value to each specialty based on my answers; I had the same score for a number of specialties so they are a tie. These are the results (with some comments by me):

1. (46 points) ophthalmology (I do not have the grades for this)
dermatology (ditto)
2. (45 points) endocrinology (I would have to do internal medicine first, #7 on this list. yuck)
pathology (um, I said I LIKE talking to people...)
plastic surgery (see #1)
3. (44 points) urology (see #1)
neurosurgery (see #1)
emergency medicine (actually one I was considering!!)
allergy and immunology (I also would have to do internal medicine first)
4. (43 points) anesthesiology (I like TALKING too much for this)
gastroenterology (internal medicine first)
physical medicine and rehabilitation
occupational medicine (I have no idea what this even is)
5. (42 points) radiology (again, I LIKE people...)
rheumatology (internal medicine first)
neurology (I am on this right now and I do like it)
infectious diseases (internal medicine first)
6. (41 points) hematology (internal medicine first)
nephrology (internal medicine first)
radiation oncology (I am not a physicist)
nuclear medicine (again, I am not a physicist)
otolaryngology/ENT (don't have the grades)
pediatrics (another thing I thought I REALLY wanted...hmm, so low on the list!)
7. (40 points) thoracic surgery (general surgery first...um, no)
orthopedic surgery (don't have the grades)
pulmonology (internal medicine first)
colorectal surgery (general surgery first)
internal medicine (hurl)
8. (39 points) medical oncology (internal medicine first)
general surgery (seriously, shoot me now with those hours and those attitudes)
aerospace medicine (no idea what this is)
9. (38 points) psychiatry (something I thought I would like but is just ok)
preventive medicine (don't know what this is)
obstetrics and gynecology (wow, this is lower than I thought it would be)
10. (37 points) cardiology (internal medicine first)
11. (35 points) family medicine (really liked my rotation, could never do it as a career)

While this list is interesting, if you look at the point spread, it is only a one point difference between each ranking and there are multiple specialties that tied at each rank. So basically, I am just as indecisive as I thought I was. There are a lot I can cross off the list, but of note is that all the ones that I said I would have to do medicine first (ex. endocrine, hematology, nephrology, etc.), I could also do pediatrics first. Now we might have something here. Even though peds is lower on the list, I always said that I would probably not do general peds, I would subspecialize. The highest subspecialty on the list is endocrinology. So I guess according to this list I should do endocrinology over emergency medicine. But again, only by one point.

Also of note, lately I have been saying that if I had 2 lifetimes to live I would spend one of them as a neurosurgeon (and that was as high as emergency on the list). I am exposed to a lot of neurosurgery on my current rotation (neurology), and I am completely in awe of the neurosurgeons and what they do...it is so amazing. However, you literally don't have any other aspect of your life if you have that as your career, and I'm not willing to devote the one lifetime I do have to my career, no matter how awesome it is. (And I also currently don't have the grades.)

Basically this was not that helpful! I just don't know myself well enough I guess, or exactly what I feared would happen is happening...I love something about everything. What to do now?

Thoughts

Just a couple things...

I meant to blog this on Monday, but I got caught up...better late than never. I had my first patient die on Saturday. She came into the hospital late Thursday night with a massive stroke. I saw her on Friday, and she did not look too good. She couldn't follow any commands, she could only move one side of her body, and couldn't open her eyes or track. I had a feeling she wouldn't make it through the weekend, and come Monday I found out I was right...she had swelling in her brain (common with a stroke) and her brain herniated through the bottom of her skull. Even though I only saw her once and didn't have a whole lot of interaction with her, I want to remember her. Everyone remembers their "first" of a lot of things (first patient, first code, first angry patient, etc.), and I think it's important to remember her.

Second, Lent starts today. I did not get ashes today because of being at work (I also didn't look to see when the services were at my church...I might have been able to make one this evening but oh well), but D and I have decided what we're giving up. Fried food and chips. We both came to this exact conclusion separately, which is hilarious. We don't eat these things often, but it is something that we would have to consciously not do, and it is something good to give up. I always try to DO something during Lent as well, not just give things up, and I haven't decided what to do this year yet. Guess I'd better figure it out in the next 4 hours before I go to sleep and do it so I don't start out behind!

V-Day

Today has been an interesting day.

7am- alarm goes off. No chance of getting up. Reset alarm for 8.
8am- alarm goes off again. Lay in bed basking in the sun.
8:30am- get up
9:15am-noon- sister's volleyball tournament with mom and dad. They did great!
Noon-4pm- eat lunch, chat with D, do laundry
4:30-5:30pm- pedicure with D. Too bad I'm so ticklish!
5:30-7pm- eat D's grandma's chicken casserole (SO good), more laundry, more chatting
7-9pm- watch The Holiday with a glass of wine

I basically forgot about it being Valentine's Day today until I left the volleyball tournament and my mom said "Happy Valentine's Day!". I have come to really hate this day. Why should love only get one day of celebration all year? I mean, it would be selfish to celebrate yourself every day, so you have one birthday; it would be silly to celebrate something like the Presidents every day, so they get one assigned day. But love? I mean, come on. This is what makes life worth living...the love you have for yourself, your family, your friends, your dog, your plush towels, etc. You should celebrate the loves in your life every day. Saying "I love you" should never be said out of routine or obligation, but look at the person you're saying it to and really, really mean it. I don't want flowers on this day. I don't want red and pink (I really dislike pink) everything. I would rather be reminded on a random day that someone loves me.

Today I celebrated loving myself. I don't have a significant other to tell me how great I am, so I decided to tell myself. I did what I wanted, I spent time with some of the people I love...I just relaxed. And that is good.



Watching The Holiday and totally being obsessed with Jude Law doesn't hurt, either.

Fresh

Quick re-cap: my last week of Psych was really fun. It was a consultation service, so we were visiting patients who were in the hospital for non-psych reasons or for suicide attempts. Their primary physicians thought there was something psychiatric going on (either causing their problem or a separate problem that needed to be addressed) and wanted our opinion on what to do about it. It was nice to sit, talk the patients about what they thought was going on or what was bothering them, make a recommendation, and walk away. I didn't have to continue to see the patient and be frustrated that they weren't getting better. I do not think I will end up in psych, but I did enjoy a lot of things about it.

I started Neuro today; it was just orientation and a lecture on neuroimaging. I am pretty excited to be at the hospital I am for this rotation. It is world-renowned for neurology, and I know I will learn so much and see so many interesting cases. The only thing I am worried about is liking neurology so much that it throws another wrench in my attempt to figure out what I want to do with my life!

This last weekend was very nice- no studying, no plans, no responsibilities! I had wanted to go on a mini-vacation, but that wasn't in the cards, so I made the best of staying at home! I saw my sister's volleyball team take first place in their tournament, saw my best friend who had just gotten into town, had a little Super Bowl party, and tried to sleep in as much as possible. It's sad to be back at school already, but being excited about this rotation helps me get through it!

Funk

I'm in a bit of a funk today.

I haven't been sleeping well at all the past few nights. I am so tired around 6-7pm, but then as soon as 9-10pm rolls around and I try to lay down to go to sleep, my mind is WIRED. It is going 3000 miles a minute. Thinking about literally EVERY aspect of my life for the next 10 years...my 4th year schedule, boards, where I'll do my residency, what I am going to do about my living situation (buy a house, don't buy a house, where, etc.), if I'll get married, what kind of stuff I want in my house, what I'll look like (if I'll have more wrinkles, if I'll be fatter/skinnier/the same, what color my hair will be, etc.), what I'll do after residency, if I want a private practice or not, how many hours a week I'll work, what I'll do outside of work...

Seriously, it goes on and on and on.

So, I'm not sleeping well. I am thinking about a lot of things. I'm a little anxious. My stomach always feels nervous (and a bad nervous, not like excited butterflies nervous). I don't feel quite like myself. I don't feel quite so confident. I seem to be focusing on the bad things about myself (or at least things I don't like) instead of appreciating all of the good qualities I have. I am fairly unsure of myself, and I find myself thinking (along with everything else) about things I've done in the past few months/things I have said and reliving those conversations/moments in my head, wondering how they looked to the other people around me at the time, what I could have said/done differently, what those people probably think of me now, what I think of myself now, etc. And it's not like I'm thinking about really monumental, decisive moments. I think of random conversations I had during the day 2 months ago or that one patient I interviewed or when I hung out with so-and-so for an hour.

This is freaking me out. And I'm freaked out that it freaks me out. Etc. Clearly I have a lot of cascading thoughts; one thought just leads into another. I'm freaking sick of it! It has only been going on 2 days but it is crazy. It had better stop soon, or I had better get a handle on it, or else I may join my patients on a psych ward! (not really, but you know what I mean) I am pretty sure that on the outside no one would know that I'm thinking all of this stuff...I am able to focus on my work and do a good job, I am able to have a normal conversation, etc. So it is not seriously disturbing my life, but it is disturbing my head!

So 2 days ago, I was totally calm and had a handle on everything. Today I'm seriously obsessing over everything. Are we done with this rollercoaster yet?!?

Relax

I have vacuumed the apartment, I'm sitting on the couch with the windows/patio door open to enjoy the BEAUTIFUL weather, and I am trying to just relax.

My 4th year schedule is essentially done. I may need to flip two electives depending on scheduling availability, but I have made my decisions. It is set up to cover me for either ED or Peds. I hope this is the right decision, but if it's not I will just worry about it when that time comes.

I am studying for the Psych shelf exam. I have enough of a head start that I think it will be alright.

I have a plan for my Step 2 boards. I think it is a good plan. Still needs some more detail, but it is starting to come together.

When I have a day like this, with beautiful weather and nothing on the schedule, I try to relax. And I am very glad that I am happy in my current environment; it makes it that much easier to ignore the small things, rationalize through the big things, and just be.

It's a good day.

Conflict

I am having a lot of inner turmoil these days. I was (smartly) advised to blog about these feelings so I can look back on them one day and (hopefully) be reassured that I thought out my situation well and made the right choice. Long post ahead, be warned.

1. My 4th year schedule is due on the 25th of this month. This is VERY soon. In order to fill this out, I need to have picked a specialty pretty definitively. At this point, I am deciding between Pediatrics, Psychiatry, and Emergency (ED). The problem I am having with this is threefold:
A. I do not have my ED experience until my elective in March. On paper, I think it sounds great (predictable hours, no being on call, shift work, easy to do part-time, exciting, no need to stay late or follow up on patients). In practice, I've got nothin to go off of, and won't until March. This doesn't help me when a decision must be made in about a week.
B. I am on Psych right now, and I am having a mini conflict about it. I went into this year with Psych at the top of my list. Now, after one week of child psych and 3 days of inpatient adult psych, I am not sure how much I like it. I knew the thing that would draw me to Psych was the theraputic part; I did not want to be a "medication manager" and ignore the patient's psyche. All I have seen is medication management. This may be the environment that I am in, but I'm not convinced that it is. I also feel like it is incredible subjective; one patient may be diagnosed OCD by one doctor and ADHD by another and be put on completely different meds even if the diagnosis was agreed on. I do not know how I would ever know that I was doing a good job or was doing it right. Also, EVERYONE gets diagnosed with something. Obviously they are at a psychiatrist because it is causing them distress, but it is discouraging. Lastly, most of these patients will not really get better, and it can be a lot of trying to convince someone to change something about themselves that they do not think is a problem. In short, like banging your head against a wall while trying to convince it that it is really a pillow. This was a long rant about Psych, but I am frustrated by these feeling because I really thought I would love it and while I like parts of it, I do not think I love it.
C. I got the score back from the Peds exam I took in December...not too hot. I passed, no problem, but it was actually worse than my Internal Medicine score, which is VERY surprising. I know one exam is not everything, but it is very discouraging...how can I believe that Peds is the right choice for me if I do poorly on it? Based on the above two worries, it would be logical to put my stock in Peds, schedule my 4th year for that, and just be done with it. I know it makes me really happy, I know that I miss being around the kiddos, I know that there are a lot of other positives about it, but this exam thing is seriously throwing me off. I should wait until I get my clinical evaluation from my supervisors back and see what that said (since what I actually do with the kids counts way more than some silly test), but unfortunately it will probably be months before I get that back. Again, not helpful when my schedule is due in a week.

2. Apart from not knowing what I want to do, I am having problems with the logistical aspects of the scheduling. There is a lot of strategy involved. For example, if I am interested in doing a Peds residency at a particular hospital, it is advised that I do a "sub-internship" there during Nov, Dec, or Jan. A "sub-i" is where I will act like an intern (interns are in their first year of residency) so that the program can evaluate me and decide if they would want me to be an intern/resident with them. It is basically an audition. So I need to be strategic about when I do my sub-i, and I also need to decide how many hospitals I want to try to do it at as well as at which hospitals. So not only do I need some idea of WHAT I want to do, but WHERE I want to do it at. How in the WORLD am I supposed to know this?!? How am I supposed to know which programs are good and which are not and which are too good for me to ever get into? How am I supposed to know even what CITY I want to live in if I haven't even ever been there? Apart from the strategy is scheduling sub-i's, there is also leaving time to interview, scheduling easier/more flexible rotations during interview season, choosing what other rotations I want to do, trying to find a research project/mentor, etc.

3. I am coming up on Step 2 of my licensing exams. Now, it feels like I just took Step 1 (which I did, last June), and I am DREADING going through that studying process again (the schedule is much the same...multiple weeks straight of studying 10+hours per day). Step 2 is divided into two parts: Clinical Knowledge (CK)- the multiple choice exam, and Clinical Skills (CS)- the practical part. There is strategy about how and when you take these exams as well. I think I have decided to take them both in the same month, which I hope goes well...just get them over with. There is a lot of scheduling involved, as CS is only offered in 5 cities and I have to travel to take it, and I need to schedule time off from rotations to study for CK. I do not want to study again and do poorly or only as well as I did on Step 1. To help me with my residency applications, I need to do better on Step 2 (particularly CK), and I'm scared that I can't do any better than I did on Step 1.

Clearly I have a lot on my plate right now and trying to stay organized and on top of the rotation I'm currently on while trying to figure out the rest of my life is very, very taxing. I have made probably 25 lists in the past week of things I need to do, people I need to email/call, things I need to study, things I need to check on for my patients, etc. I guess I have learned that about myself...when I get stressed, I write lists. It is a little pathologic (I'm probably looking at it like that because I'm on Psych!), but I don't know how else to feel like I have any handle on everything that is going on.

This has been long enough. There is more, I'm sure, but that is all for now.