How to Have Merry Christmas When You’re a Broke Student

I found myself giggling this morning, realizing its exactly 3 days until Christmas. I’m hoping for snow (don’t hate me!), and juggling shopping trips, coordinating the menu planning for an extended family get-together, and enjoying endless reruns and Christmas music.

This year is quite a bit different than last – after all, I’ve joined the ranks of “broke student” and wear the identity proudly. Well, not exactly the “broke” part. That one can be a little tough. But I’ve found ways to make Christmas super fun even on a super tight budget, and thought I’d share some ideas here in case it might help someone else.

  1. Consciously CHOOSE to have a great time together with friends and family, completely disconnected from the gift-giving part.

This year, our family is all getting together a couple of days after Christmas. We planning an informal “lets get together and eat good food, sing songs, play games, with NO gifts.” Its an experiment of sorts, designed to give everyone a break from the gift-giving stress. Remember that the greatest gift you can give is the gift of your presence.

2. If you’re going to give gifts, consider making them.

One of the most enjoyable memories I have from childhood is a Christmas when our family had exactly zero resources to spend on Christmas gifts. So we made them. We used old newsprint salvaged from the newspaper office and decorated it with potato prints dipped in paint for wrapping paper. I gave my mother a hand-painted watercolor that I’m sure betrayed my age and (minimal) talent but she loved it. Scour second-hand stores too for those nuggets of super cool and super cheap gifts, or check out a Dollar Store. You don’t have to spend lots of money to have a joy-filled Christmas!

3. Be willing to let people know you’re a “broke student” and would really appreciate cash or gift cards for Christmas.

People really do want to know what you’d like! And if “what you’d like” is cash and/or gift cards, let folks know.

4. Especially if you’re a non-traditional student and have your own children (but equally applicable for single ‘broke students’), make full use of your town’s resources.

Just about all towns and cities in the United States have things like food banks and even community centers that exist solely to help out struggling individuals and families. Don’t let your pride keep you from asking for help!

5. SERVE.

This last point is what I consider the most important. When you’re struggling to juggle bills and groceries and somehow have a few pennies left over to enjoy Christmas, its easy to lose sight of the importance of service. But I promise, as you give, your heart will hugely benefit. And serving will get you out of the self-focused stress and let you focus on someone else’s needs for a bit.

From my home to yours, here’s wishing you a peaceful and joy-filled holiday season. Merry Christmas!

The Importance of Sprinkles

Its Christmas break – a few weeks to breathe, sleep, and eat between Block 2 and Block 3 of medical school.

(I won’t hear officially if I passed Block 2 finals until after Christmas. Typical of me, I’m trying hard not to stress / think about i!)

Downtime is precious. No stack of flashcards. No lineup of lectures coming up tomorrow. No countdown to the next midterm. No alarm clock set for 5am to make certain I get in enough study hours.

Its a little funny-feeling actually.

Because I live my life intentionally, I’ve decided to use this down time to choose JOY. Here’s some of the ways I’m doing that.

  • This year, I’m not leaving Christmas family time to chance, and I’m determined to excise all stress-factors from the experience. We’re keeping it simple. Except for a few immediate family members, we’re not doing gifts. Instead, we’re intentionally spending time with each other. Because that is what’s most precious to us about Christmas.
  • I have a year-old white German Shepherd who’s still very much a puppy, and who looked a bit confused sometimes during the last term when I had time for little more interaction with her than to make sure she had clean water and food and a place to curl up beside me when it was sleep time. So I’m using this time to play with her more. Puppies are awesome for giving immediate positive reinforcement for giving them attention.
  • Sprinkles. What is so magical about sprinkles? Next time you make a batch of cookies, slather on a healthy layer of icing, then generously add tons of sprinkles. Let those sprinkles make a mess on the counter. When you take a bite, let those sprinkles float down to your lap, stick to your fingers, even fall to the floor.

With all the little things I’m doing this year to keep the holidays stress-free and to intentionally fill back up, I’m lovin’ the sprinkles. Sprinkles are like JOY. Start using them, and they start getting into everything.

Exactly as they should.

From my home to yours, here’s sending you sprinkles of JOY for this holiday time. Merry Christmas!

An ER Argument (or The Strep Conundrum)

Last night I got into an argument. It started out as a 2-way argument (me and the hospital’s medical director who I was working with at the ER), then turned into a 3-way argument when my mentor Dr. J joined in. It wasn’t about who was right and who was wrong, not at all. But three intense personalities had intense opinions, and all three of us had no problem expressing those opinions.

Its sometimes a bit weird, being a “mature” medical student. I’m older than both of the docs I argued with last night – not that age per se has anything to do with it, but I do think my age / generation has its own particular viewpoints on doctors and treatments and the sweeping changes affecting medicine. I have, after all, half a lifetime of experiences with real life, being a patient and the mother of four kids who were often patients. And over the last 30+ years, medicine has changed a whole lot.

We’ve gone from “the doctor is god” mentality, to a collaborative effort between doctors and patients. With the advent of the internet, patients now often Google their symptoms and potential treatments before they ever show up at their doctor’s office or the Emergency Department, and are sometimes quite adamant about what they have and what they need or want.

The last 30+ years has also seen a huge shift in use of antibiotics. Growing up in the 60s, I had more than my fair share of strep throat infections, and for whatever reason my parents chose not to have my tonsils removed. They simply called the family doc (who made house calls and always made me feel so well cared for) who would peer at my pus-pocketed ginormous tonsils, then routinely prescribe me a round of Penicillin. In fact, I had it so often as a child (and quite frequently didn’t complete the regimen) that Penicillin simply doesn’t work for me anymore.

With that background, I was stunned the first time I heard my mentor, Dr. J, tell a patient that there was no need to prescribe an antibiotic for their strep infection – that the current research showed it simply wouldn’t help much, and that their body would most often clear the infection on its own. That was a couple of weeks ago, and I of course went and did my own research.

While many docs still prescribe antibiotics following a positive strep test, just as many don’t. And the latest research does indeed seem to indicate that the body will clear a strep infection without the use of antibiotics.

Enter my “position” – my opinion based on personal experience.

Turns out my mentor Dr. J had frequent strep infections while working in his medical residency program, and experienced fast symptom relief each time he began an antibiotic regimen. But notwithstanding his personal experience, he will give his patients the latest research findings, that strep infections most often don’t need an antibiotic.

Dr. U, the hospital medical director and I, had a rousing “discussion” last night about this. He is adamant about not over-using antibiotics. And I see his point – in an up-close-and-personal way. After all, the list of antibiotics that I can effectively take is growing smaller.

Could it be that this is part of a greater problem? Our society has long wallowed in the “fix-me-fast” mentality. A pill for everything, and that pill is expected to fix symptoms from a sore throat to a headache to indigestion to STDs to insomnia to high blood pressure to pain to depression to …. well, just about everything. I’ve been saying for years that it really is okay to have a fever, or a cold, or pain, or whatever, without needing to grab a pill for a quick fix.

So I was rather surprised at how resentful I felt during the “argument” last night. The double standard (I want a pill to fix a sore throat no matter what the research says, but to be a good doc I need to not give a pill to my patients with a sore throat) was glaring.

How about you? Did you grow up knowing there was pretty much a pill for whatever ailed you? Did you take “too many” antibiotics and now have a smaller list of those that are effective? How do you feel about the wind-shift among physicians to prescribing less antibiotics, and educating patients more on allowing their bodies to heal themselves (even if that means a few more days of discomfort)?

Post Finals Phenomenon

I slept. For about twelve hours.

Having stressed and studied and juggled life, after finals I was in bed about five hours earlier than normal. Now the next day, I’m realizing there’s a pattern here.

I call it my Post Finals Phenomenon.

Kinda like a predictable hangover, the day after finals has a predictable emotional hangover.

What if I didn’t pass?

What if not having internet for a week during the move was time unrecoverable? What if I didn’t guess right on the questions I wasn’t sure of? Why why did I guess that way on that question? What was I thinking?

I will tell you, these thoughts are predictable for me the day after finals, even with many precious people in my life who assure me daily that I’ve got what it takes to successfully pursue my grand dream of becoming a physician.

If you know someone pursuing a grand dream and wonder why they’re expressing insecurity, let it be. Its predictable. Keep on reminding them of your support. Let them know your support is not predicated on them successfully reaching the goal, but is simply because they are them and you are you.

If you are someone pursuing a grand dream and are feeling insecure “post finals”, let it be. Its predictable. Express whatever you’re feeling to those you know will hear you and accept that its part of the “emotional hangover”.

Because I’m who I am, it actually helps me to have in the back of my brain the recourse of a retake if I totally flub on a final block exam. While my intention is always to do very well, knowing that this isn’t a “one-shot-all-or-nothing” deal helps to calm my panic when those thoughts of OMG I’M SURE I FAILED! intrude. It also really helps me to remember that I felt this way after last block finals, I’ll probably feel this way after next block finals, and feeling insecure is an acceptable feeling even for this super-intense-driven-loving-the-process person.

Here’s a few other things I’ve found that can help with those pesky post finals phenomena.

  • Sleep. Sleep a lot.
  • Exercise. Not obsessively, but consistently. Take the dog for a walk. Go on a hike with friends. Jump on the treadmill or stair climber. Sit in the sun. Dance in the rain. Make snow angels.
  • Eat. Cook simple and healthy meals, and enjoy a sit-down meal without your flashcards in hand or the time-crunch of needing to get back to studying.
  • Laugh. If your “emotional hangover” hangs on longer than a day or two (the time it usually takes to catch up on sleep), jump start your recovery by finding things to laugh about. Go see a comedy. Hang out with little kids. Watch your favorite comedian on TV. Laugh even when you don’t feel like it – I promise your emotions will catch up.
  • Serve. Nothing is more guaranteed to get you out of your self-obsessed worry about grades, than serving someone else. Reach out to a homeless family. Volunteer at a local food bank or shelter. Go through your closet and give away what you haven’t worn in the past year. Sponsor a family for the holidays and get to know them. Your heart will let go of your insecurity as you reach out.

Whether you just finished final exams, exams are coming up in the next few days, or know someone who is struggling with post-exam insecurity, remember this: Just like an actual hangover is predictable and lessens with time and healing, so too the emotional hangover of insecurity is predictable and will lessen with time and healing work.

What have you found to best help you get through the hours and days of insecurity following final exams, or following any big-deal-thing that leaves you feeling insecure?

Hands On Patients

In the few days between right now and Block Two’s final exams, I took a few hours last night to work once again in the Emergency Department of our local hospital. And once again got to experience a few “firsts”.

A handsome young man was brought in having overdosed on Benadryl. Part of my mind flashed to my own young-adult son, and I ached for his parents trying to cope with this image of their son that I’m quite certain they wished had never happened. At the same time, one of the ER docs I hadn’t worked directly with before said, “Glove up and come help” as it took a whole team of folks to hold the patient secure while IVs and a catheter were placed. Then a rapid fire conversation (well, her asking questions, me saying “I don’t know” a lot) that ended in her grabbing a mobile computer, logging me into the system, and saying, “Research the difference between sympathomimetic toxidrome and anticholinergic toxidrome. You have five minutes to come find me”.

Breathless and excited to have answered questions in less than the five minutes allotted, I was looking for my mentor when Dr. M grabbed me once again. “Come help me with a lumbar puncture.”

I felt obligated to mention, “You do remember I’m a first year right?”

Dr. M: “I don’t care. I’m treating you like a 3rd year. By the time you really are a third year, you’re going to know exactly what you’re doing. Make sure you’re keeping a list for your portfolio – its important because believe me, you’ll forget your first lumbar after you do a dozen more.”

Fast stop at the desk surrounded by textbooks in a back corner of the ER, Dr. M grabbed a thick text titled “Emergency Medicine” and flipped to the section on spinal taps: “I know its a lot, read this section on technique. Read fast. You have five minutes to come find me in room 3. What size sterile gloves do you wear?”

I have rarely so blessed my gift for speed reading as at that moment. Six pages scanned, at least the basics retained, I found Dr. M in room 3 and quickly gloved up. Patient placement. Family seated (don’t want to have to worry about family members passing out while doing a procedure).

I truly figured I would just watch this time. After all, I am a first year student. I wasn’t quite prepared for Dr. M to say, “Okay, show me how you determine the puncture placement.” Scanning in my mind’s eye through those six pages I had speed-read just five minutes before, I found the iliac crest, felt for the space between L3-L4, and silently blessed this young patient who was making it so easy. (I nearly giggled as Dr. M marked the spot using a sharpie, and flashed on all the times I had told my then-teenage son to stop writing on himself hehe!) Then I swabbed the area with Betadine in exactly the way shown in that text I’d read and was just a teeny bit gratified to hear, “Well done” from Dr. M.

The rest – injection of local anesthetic and the actual collection of CSF – that part I just observed. After all, I really am just a first year student. But mentally I recited the layers the needle passed through, “saw” the little ‘give’ as the needle first passed through the ligamentum flavum, and a second little ‘give’ as it passed through the dura.

As crystal clear CSF dripped slowly into the collecting tube, the patient said softly, “I don’t feel so well” and the nurse standing in front of her gently supported her head as she quietly fainted (and I remembered Dr. M telling me to always make sure I have a nurse with me when doing a lumbar puncture – now I have a first-hand view of precisely why).

With the spinal tap complete, the lesson was only half done. Results came swiftly, and I then was asked to explain the significance of no gram stain, low protein, no white blood cells, one single red blood cell, glucose within normal limits, and a clinical picture that pointed to probable multiple sclerosis – What’s the next test? 

I discovered that while Dr. M is super tough and pushes me hard, she also has great patience with my floundering to put words to what I do know and what I don’t. And super cool icing on this cake was finally finding my mentor and him suggesting, “Okay, now that you’ve done it, explain it all to me as if I’ve never done a spinal. You teaching me will solidify it in your brain for the next time.” As I explained the lumbar puncture technique, this particular patient, what the test results meant, and what was next, I found the words coming a little more easily.

Now its Sunday morning. Writing out last night’s adventures I get the butterflies now that I didn’t have time for then. And I am overwhelmingly grateful for every single speck of the amazing experiences I am privileged to have.

Now, to flowcharts, flashcards, and whiteboards. Block final exams for immuno, micro, and pharm are in just five days. Funny how much more motivated I feel about endlessly reviewing bacteria and viruses having done a little real-life work last night.