Category Archives: personal progress stories

Hiccups and Redirects

Being an adult medical student has its distinct advantages, and a few disadvantages as well I suppose. I’m an eternal optimist, so the downsides don’t really affect me much. But a friend asked me to address at least one of the downsides just to make sure folks know its not all sunshine and roses on this journey!

Probably the biggest downside so far has been having to take a leave of absence.

Most definitely not my favorite thing, having to write to my school and request a break. But since my school doesn’t offer federal financial aid or scholarships, I’m left solely responsible for tuition. Now don’t get me wrong, I am over-the-moon thrilled at the (relatively) low cost of tuition at my school. That said, its still high enough that one little life-hiccup can upset the fine balance of keeping up with payments while still being able to do things like buy groceries.

Sigh.

Being the optimist that I am, I took the break time to dive deeply into powerpoints, recorded lectures, and study aids. Its fascinating to me how much knowledge a brain can hold, and even without a deadline of upcoming exams I was able to spend daily hours in productive study. That Step One review book is becoming my best friend, and q-bank questions are my second ‘job’.

All that to say this: Regardless of what journey you’re on, if you’re passionate about the goal, don’t let anything sidetrack you or make you give up. Will it be hard? Absolutely. Will the journey include hiccups and re-directs and sometimes discouraging detours? Sure. Real life doesn’t offer a straight line from here to there.

But any goal worth having is worth working for, striving for, doggedly slogging through any mess for. As I continued studying and putting in clinical hours, I discovered that any sacrifice is worth it in the pursuit of this grand dream of mine.

Whatever you do, just don’t quit!!

This Funny Foreign Language…

I love learning.

Truly, there is some hole in my soul that is filled best by the process of learning all things medical and scientific.

However, please forgive me while I have a mini-rant moment.

After spending a few hours studying Autonomic Pharmacology, I’m convinced of just one thing: Whoever named these various processes was hallucinating, was hopelessly psychotic, or just had a sick sense of humor knowing future med students could quite easily feel their brains explode simply by having five words that meant the exact same thing.

Here’s just one example.

Muscarinic antagonists

aka antimuscarinics

aka muscarinic blockers

aka parasympatholytics

To say nothing of the adrenoceptor antagonists and sympathoplegics…

Here’s the super cool thing (realized after I went through the material four times and it actually makes sense)…

Just a few days ago I was with a patient in the ER who needed Metoprolol. Now I understand better why it was needed, how it works, and why that was the right drug choice in this case.

Then there was the patient who came in with an overdose – after today’s study session, I better understand anticholinergic toxicity, inhibition of cholinergic neurotransmission at muscarinic receptors, and why certain treatments are and are not appropriate.

Here’s the thing.

I make jokes about the sometimes ridiculous and convoluted new language I’m learning – just because its actually rather funny to me that there’s so many very long nearly unpronounceable words (and goofy awesome when I can say and spell them and describe what they mean). But far more incredibly cool for me are those moments of putting it all together – the academic details with the clinical application.

I look up and six hours have passed. I know far more than I did six hours ago (even if the way-too-long words are ridiculous), and there’s still so much more to learn. Now on to the indirectly acting cholinomimetics (AChEIs)!

Hashing It Out

Maybe the day will come when I’m not giddy-excited about experiencing a “first”, but today was not that day.

Today I spent four hours with 3rd and 4th year medical students for their weekly didactic session. Living in a small town, I wasn’t sure what to expect. After all, small town means small hospital and small teaching program, so I tried to have “realistic expectations” not even knowing what that might mean.

At the same time, I was hugely honored by being asked to participate.

Four hours hashing through cases, asking and answering questions, participating in an intense brain-storming session coming up with differential diagnoses and treatment options, analyzing the diagnostic tests used, listening to some serious “constructive criticism” directed to those who presented cases. I realized I am beginning to actually know some stuff… a technical term for sure (ha!) but more-so an emotional experience when I realized I was participating in a discussion and understood the science and service of what was going on.

There are so many ‘bits’ to this journey that, taken together, will help mold me into someone called a physician. Some days are just “keep plugging away” days – the hours and hours of lectures and charts and pictures and pathways and diseases and treatments. Then there are the over-the-top days when I get to serve – when I can “practice” by being up close and personal with real patients with real problems and I have the chance to serve. The third part of this amazing journey is these unanticipated intense learning opportunities – chances to participate and grow on a level I never even knew possible.

For all the years – decades – that I’ve tried to imagine what it would really be like to do this, I never once came even close to imagining how wonderful it would be to be a medical student.

Wonder.

Full.

Full of wonder.

Best description ever.

 

Imperfect Competence

Today was clinic day – spending time with my mentor Dr. J while we spend a few hours each week at one of the local college clinics. Migraines, yeast infections, PSVT (that’s a cool one – had to look it up) and post concussion syndrome meaning no more soccer for awhile. I still jump a little inside when Dr. J looks at me and says something like, What was the rule about when you can return to active sports following a concussion?  expecting me to explain to this student what has to happen before she’ll be cleared to return to active sports participation.

It was also class day. I had queued up the online lecture prior to leaving for clinic, then dashed back in the door one minute late, stuffed the headphones on my ears, and was instantly immersed in bacteria and viruses and (oh no not again!) biochemical pathways of metabolism.

During the ten minute break between lecture hours, I checked my school email.

And there it was. Subject line, “Block One Exam Grade and Status Report”.

That exam that I have been stressing over, worried about, just sure that I didn’t pass because there were far too many questions I had to guess on. Part of my brain went into hyper mode, analyzing the Subject line, wondering if that was a precursor to some elaborate email about what to do if you didn’t pass the final. Heart racing, I clicked and read…

PASS.

Not even “low pass”.

Truly, sitting here writing this, I’m not quite sure how that happened. There were  far too many questions I had to guess on.

My heart rate gradually slowed back to normal as I’ll admit I shed not a few tears. I flashed back on all the times in the last few months I’ve heard professors remind us that medical school exams will never try to trick us, but will most definitely constantly test our ability to evaluate a situation we’re not familiar with and apply the knowledge we do have in order to come up with the best reasonable response.

Maybe I need to reframe the way I look at this. Maybe I have to stop calling it “guessing”, let go of my ‘undergrad-style’ memorization expectation, and realize that while I cannot memorize everything, I can learn. I can apply what I do know. I can rely on all those hours of pouring over q-bank questions that asked about scenarios I’d never heard of and walked me through the process of understanding how to apply what I did know to what I did not.

I’m the type of person who has always needed to compete with myself for as close to flawless as possible in order to feel adequate. I’m discovering a whole new dimension to learning and application than I ever knew existed – based not on perfection, but on competence.

I have a feeling this is going to be an ongoing and amazing learning experience – not just about what information I can store in my brain. While I learn. And serve. And become.

The JOY Factor

Block One is in the past. A week of “downtime” is over (packed with an almost inhuman heap of amazing accomplishments). And Block Two is ramping up.

I’ll admit, I’ve been a bit trepidatious about going into Block Two. Its all about Microbiology, Virology and Pharmacology. Okay – a better way to say that is this: I’m nervous studying bacteria, viruses, and drugs. This is delving into subjects I’ve never taken a course in before so I’m back to that place of feeling inadequate without any academic foundation for what’s next.

Besides, I was kinda used to the intense and animated teaching style of our Biochem professor. Until today, I imagined that our Micro prof would be a stodgy old guy droning on about e.Coli and enhancers / repressors and blood typing and….. well, that was the beginning and end of what I thought it would be like.

And then there was today.

I hope that you, whoever is reading this, has at some point in your life had a conversation with someone who just overwhelmingly loves what they do, and has a real gift for infusing the discussion with JOY.

That’s the only way I can think of to describe what today was like.

A conversation (not a dry stodgy lecture).

With animated JOY.

About bacteria.

Just writing that makes me feel like giggling. And reminds me how important that JOY FACTOR is. I don’t ever want to wait until my life circumstance is all carefully arranged to justify joy. Today was a beautiful reminder of how I have the opportunity to choose JOY, no matter what is going on. No matter the subject. No matter the company. No matter of other areas of my life are challenging at the moment.

That JOY FACTOR. Wow. If it can transform a potentially dry subject (bacteria and viruses) into an animated interactive super cool conversation….. well, I’m going to be applying this in a few more areas of my life and watch the stress levels evaporate.

Funny how much energy I wasted in the last week worried about this. Liberating how fast the JOY FACTOR was contagious.

Grab hold and pass it on!

 

What Do You Think?

“Working” at the free clinic in my little town brings back so many memories!

This is the clinic I volunteered at way back when I first returned to college, not sure if I was cut out for the whole pre-med adventure.

Its also a clinic I’ve gone to as a patient at various times over the last decade.

As Dr. J and I breezed in yesterday for our shift, patients were lining up, some already waiting in exam rooms. Back aches, sore throats, medication refills, an arthritic knee that needed a steroid injection for a delightful elderly Spanish woman who spoke no English at all…

Then there was the patient I’ll call Ann (not her real name). Ann also spoke only Spanish. Although Dr. J (my mentor) is fluent, I speak very little (gotta work on that!). But I found myself following the gist of what Ann was describing. A petite woman, she was also a little strange – the sort of patient easily dismissed by medical folks who have better things to do than listen to a frumpy confused woman describe her aches and pains in a long rambling monologue.

Dr. J patiently listed, asked many questions, then looked up at me and said, “I just don’t know what’s wrong. Maybe nothing. Maybe something. Let’s get her to come back tomorrow for a blood draw – maybe that will give a clue about what’s going on.”

Standing in the tiny corner “doctor’s lounge” while Dr. J wrote up the lab slip, I mentally went back over what I had gotten from my limited understanding of Spanish, Ann’s body language and hand motions describing her discomfort. Suddenly Dr. J stopped what he was writing and looked up at me.

So, what do you think it is?

“Well, she’s got right flank pain. Belly pain. Feels just generally yucky. She’s wearing super tight pants, which she probably wouldn’t be doing if it were an intestinal issue. My first guess would be a urinary tract infection of some sort.”

But her pain is on the side, not the back. And she said she doesn’t have burning on urination. And she said its been going on for three weeks without a fever which just doesn’t fit a UTI.

“True. I just keep thinking, as a woman, the times I’ve had a UTI, it hasn’t been textbook. She’s a poor Spanish woman with no insurance, so she won’t quickly seek medical attention when she doesn’t feel well. She’s a little / a lot weird, so probably has some sort of mental health issues. Bottom line is, how cheap is a pee test just to rule out a UTI?”

Suddenly Dr. J jumped up and found a nurse. I need a quick urinalysis on Ann please.

Fifteen minutes and another patient later, the results were back.

Well look at that – definitely has a UTI. You were right – good work.

No time to enjoy the kudos as I followed Dr. J while he wrote a fast prescription and then off to see the next patient.

Later, though. Later, I thought about the experience of having an idea of what was wrong and being willing to express it to my mentor. Even though I’m a student and technically “don’t know much”, and I have no idea yet how to read that urinalysis to determined that Ann had a UTI. But I sure did enjoy that doctorish moment – and would have enjoyed the moment even if my idea had turned out not to be correct.

Poor patients. Confused patients. Whining or weird or argumentative patients. All the reasons I have always been drawn to working at this clinic that serves those no one else will see.

So much of why I pursue this path to becoming a physician.

 

What It Really Feels Like

Its Friday night.

The Biochem note cards are put away. I’ve logged out of the school lecture notes and recordings. Block Exams happened yesterday, and I actually slept for twelve hours last night.

I wasn’t going to write anything more until I got my grade report and could write a post something like, Yippee I passed!

But that’s not how this works.

Tonight is the emotional hangover after exams are done.

You see, I have this habit of JOY and HOPE. Its where I live. Its been carved into the cells of my body and soul over years and decades of tough life stuff that gave me a choice of either despair and mediocrity, or choosing to pursue my Big Dream while holding on to who I am with no compromise.

Even though that habit is powerful, it doesn’t negate the emotional hangover tonight. Thoughts of, What if I didn’t do well enough? What if I guessed wrong on the questions I wasn’t sure of? What was up with those questions about xyz that I truly can’t remember ever hearing about in a lecture or reading on a q-bank question? 

This isn’t an appeal for sympathy or support – lord knows I have heaps of support from some amazing people in my life. What it is, though, is a testament – a statement – about what medical school is really like.

Its frightening, at times. Its overwhelming, often. And here’s where it gets super important: How my professors and other school support people responded to my insecurity tonight is HUGE for me. Here’s what that looked like:

The very last bit of this “Block” was to submit an assignment through software called DxR Clinician. At IUHS we’re fortunate to have the creator of DxR, and it is a marvelous way to simulate patient care all the way from a new patient walks into your “clinic”, through history taking, physical exam, creating a differential diagnosis, and doing the details of documentation required. It can be overwhelming (at least it was for me), and I even got the diagnosis wrong but submitted the assignment anyway.

When I sent in the email, I wrote, “I worked very hard on this assignment, and got the diagnosis wrong in the end. I am confident that with more practice I’ll do better.”

And immediately I received the following email back. After hours. Actually quite late on the east coast where the response came from.

You are allowed and we encourage you to complete the case several times so you can learn from the feedback and get everything right! We give extra credit for completing multiple attempts as well. I promise it will get easier.

And I got a warm fuzzy feeling realizing that I’m at exactly the right place, with the most amazingly supportive faculty and staff.

Soon I’ll have that grade report. And I hope I passed finals. (Yes, that’s how I’m feeling tonight, so I’m not going to dress it up in goofiness or ‘I’m sure I passed’.) But in the meantime, I am confident I’m exactly where I need to be. Being human. Feeling insecure. And with folks actively encouraging me to keep going.

It feels very good.

 

One More Step…

Twelve hour study marathons have become my new normal. I started out only being able to study productively for a couple of hours, and then my eyes would get droopy and my brain would feel foggy…. but now, I’ll only realize how long its been when I get hungry or life stuff happens to pull me away from the q-bank review or stack of flashcards.

Its so funny to me how nervous I get, how hesitant I am at trusting my recall. I know some of you will just roll your eyes at this, but I’m not really talking about thinking I’m not smart enough for my grand educational venture. What I’m talking about is a CONFIDENCE factor. And how blown away I am to see evidence that I know what I know.

Case in point: Just got second mid-term grade report, and nearly cried seeing the high pass score.

I had a flashback to that first year when I returned to undergrad in my mid-40s, determined to see if my brain could handle a pre-med curriculum without any foundation whatsoever. And how I’d study for hours and hours trying to get to the point of answering every question correctly on General Biology tests.

This time, I only missed two questions.

In just two more weeks, I’ll sit for the final. It will be a test of my courage, as well as a test to see if I can adequately recall all those little details of Biochemistry. I’m nervous already! But I’ll say this: it helps tremendously to have my little pile of stonesthe growing mountain of evidence that says YOU CAN DO THIS.

You know what’s funny? This isn’t “hard”. At least not in the way I thought it would be. Its simply a whole lot of information. And, I can do this!

Choices

I had changed my phone’s ring tone to be something a little less harsh, but it didn’t help much when my alarm went off at 5:30 this morning.

One super cool thing about being an IUHS student is that the courses are all available online. A part of that is the creative scheduling that needs to happen to accommodate our professors’ very full schedules. This morning, that meant my classes began at 6am.

Now understand, I’m pretty much a night person – my brain seems to do its best work right up until midnight, and mornings… well, not quite my favorite time. However, I crawled out of bed this morning, grabbed a steaming cup of coffee, then sat in my recliner, laptop on lap, and let the lecture roll over me as my pup curled around my fluffy slippers and kept my feet warm.

I’m convinced, SO MUCH is all about choices.

Every day I have people tell me, Oh I couldn’t do that – I don’t like studying. Or, I couldn’t do that, I can’t manage my time well. Or, I couldn’t do that… <insert excuse>…

Hold up now. Its ALL about choices! And it has very little to do with my particular choices, and everything to do with the fact that EVERYTHING IS PRETTY MUCH A CHOICE!

I can choose to drag my sleepy butt out of bed at 5:30 and join a lecture a couple of hours earlier than ‘normal’. I can choose to do it with a smile or not.

I can choose to treat people well. I can choose to complain, or not.

I can choose to take chances or I can play it safe.

I can choose to change my life no matter how hard it is or how long it takes. Or not.

See, EVERYTHING is about choices.

Not only the literal direction of my life. But perhaps even more importantly, the ATTITUDE I choose while on this amazing journey.

Now, going to refill my coffee and get settled for today’s class #2… while I choose JOY for the day.

How about you?

 

Through the Blah Days

It was bound to happen. After days and weeks of intensity filled with preview, review, studying, flash cards, q-bank frustration and conquest, and seemingly endless pathway drawings on the whiteboard that started looking like the chicken scratchings of a three year old…

Then today, its just a “blah” day.

No excitement. No tingly feeling of anticipation of the next pathway beautifully drawn, no feeling of accomplishment over perfectly remembering that enzyme or obscure disease state that the prof said “is high yield on Step One”.

That’s it! No feeling.

And, since when is my commitment, my choices, my continued studying routine based on my feelings?

When I was younger, how I felt so often dictated whether or not I had a productive study day. If I didn’t feel it, I somehow couldn’t pull together the mental focus to efficiently study. I’d waste time surfing social media sites, then end the day wondering where the time went. And I’d later berate myself for that lack of focus.

STOP!

I now know this: My commitment is not “feelings” based.

My commitment is just that: a commitment.

I define my commitment this way:

Actions I will take in this moment regardless of my emotional state, that move me steadily toward my stated goal.

So… if you find yourself smack-dab in the middle of a BLAH-day, take heart! Your commitment to action in this moment need not wait for your emotions to be “ready”. In life, in school, in business, as a mom, I’ve learned this.

When my emotions aren’t in that place of excited joy-filled experience, its a little harder to dive into the q-bank, draw biochemical pathways, and memorize things like lysosomal storage diseases. But from a few decades’ experience I know that as I continue taking action, my emotions will catch up.

So… back to the white board. This time I think I’ll draw smiley faces as I review pathways… hey, ya gotta have a little fun with this stuff!