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.

Delayed

Well, now that I've been on Peds for a month, I figured I should write something about it...

I L-O-V-E it!

My first three weeks I was on inpatient in the hospital and I think I have decided that the hospital is the place for me. I get SO bored in clinic...most of the patients are healthy, they do NOT need to be at the doctor. I understand the importance of being healthy and staying healthy, and especially for kids I understand "well checks", but they are the most boring things ever. People in the hospital need you. They are sick and there are usually a lot of things that need to be done for them. Things can change very quickly, and I like that. Keeps me on my toes.

Aside from being in the clinic right now, overall I am obsessed. The kiddos put me in such a good mood. I was getting so frustrated with the adults that caused a lot of their own problems and were not willing to fix them 70% of the time. The vast majority of the time, parents are trying to do what's best for their kids, and if you explain to them what they have to do most of them will do it. Most kids had nothing to do with the problems that they are having, and if they did (ex. they swallowed a penny) it is still pretty cute and funny, not frustrating and annoying.

My time has not been perfect: I had one patient "code" (not a true code since she still had a pulse...just "insufficient respiratory effort") twice in 1 week, some teenagers that were just whiners, and some pretty sad social situations to deal with, but just walking into the room with a kid I smile. Since I was considering psych, ED, or neuro, I can still do those but just with a peds concentration. OB doesn't have a peds specialty, but other than that all this experience does is sort of focus me to doing PEDS neuro or CHILD psych, etc. Unless I become a general pediatrician...then all bets are off.

This is a shocking development for me...I was CERTAIN going into this year that I did not want to do peds. This started to change on Family when I got so excited to see all of the kids every time. This rotation helped confirm that for me. I am not committing to peds (or anything else!) at this point, but it definately excites me!