September 29, 2013

The B word

It's Saturday night, and two of my friends and I are doin' what we do: sipping wine, knitting, watching Pride & Prejudice (Keira Knightley version. Yes, I know the BBC one is better, but who regularly has 6+ hours for P&P?).  The movie is over, we've muted the credits (despite the lovely score) and talk turns, as it always does these days, to residency applications and rotations.

Maybe it's the soft rain hitting the trees and pavement outside, and maybe it's the melancholy touch of cool in the air coming through the windows, but tonight the talk is different, deeper, more honest.

We talk about the B word, but before we even talk about the B word, we talk about the A word: apathy.

Part of fourth year seems to be this glorying in apathy.  "Who wants to do that admit? Not me, 'cause I'm a fourth year! Don't we have some JMS up in here?"  "I could tell the resident sort of wanted me to stay but I was all, 'peace out! I'm a fourth year!' " These aren't the stories we tell tonight, but they're the ones we've been telling: to our classmates, to our fourth year friends at other schools...we revel in the fact that as senior medical students, we were told that now we've "made it" and with ERAS submitted, all bets on effort are off.

One of my friends says something that strikes a nerve: "I'm not afraid of the mistakes I might make as a resident when I'm tired or I'm on call for long hours.  I'm afraid of the mistakes I've made when I just didn't care."  The essential truth is this: when you're tired, yes, of course it's easy to mix up a medication name or a dosage and make a mistake.  What's worse, though, is that sense that what you're doing doesn't matter; the resulting apathy sucks all the drive to be diligent and detail-oriented right out of your mind.

What has brought on this disregard? It's not the patients; many of the stories we tell (sans identifiers, of course) are the patients whose care has changed us, fundamentally.  The patient who was deathly ill in the MICU; the patient who lingered on; the patient we grew too attached to; the patient whose care had been delayed or inadequate elsewhere--these are the patients who stick with us, the negative examples whose care has shown us the pitfalls of medicine and, occasionally, its strengths.  These patients are what strengthen us; each one is a line tattooed on the heart and connects the disease to the person who suffers.

Instead, this overwhelming fatigue is what makes us stop caring.  For many of my friends, we took all twelve months of third year filled with academic requirements and one elective, to earn a much-coveted third month of vacation as fourth years.  Yet the first few months of fourth year are consumed with anxiety: high-stakes electives or sub-internships in our field of choice, compiling and submitting our electronic residency application, finding mentors to write letters of recommendation, studying and taking eight- and nine-hour board exams.  All of this just weighs upon us, and everyone keeps up the mantra that the class above us repeated ad nauseum: fourth year is awesome, it's the good life, it's your last chance to relax, it's when grades practically don't count, fourth year is awesome.

But it doesn't feel awesome right now.  We are tired, so tired.  When I go on dates, the guy wants to know what I do "for fun" or in my "free time." I am more and more reticent to answer, knowing my response is too often "Collapse on the couch and watch Hulu.  Does that count?"

This was my first "vacation" time in 14 months, and I spent it studying and taking board exams as well as submitting my residency application.  Next month feels like a "real" vacation, but it's an anatomy elective.  Medical school teaches you to always be working, so that doing only half as much work feels like a vacation.

At the beginning of med school, we must have had lectures on Burnout--the B word--several times over the course of the first year.  "It will happen!" and "Beware--seek help!" were what they warned us.  They neglected to mention that medical school itself engenders burnout. I can't imagine what residents must feel after a time; for me, ever the optimist, I lay my hope in the fact that I'll be doing what I've wanted to do for nearly my entire life.  I'm hoping my unbound enthusiasm for women's health will carry me through the day.

Maybe fourth year will get better.  Perhaps this is a product of anxiety about interviews (or a lack thereof); perhaps once you've been on a couple interviews you can start to live the badass, carefree life you've been promised.

After all, we're fourth years.

September 22, 2013

It's a slow, deep breaths kind of day

Step 2 CK taken. Wine drunk. Pot roast braising. Music playing.

Just a few more days, and I will have some much-deserved, much-awaited respite: true vacation. Today and tomorrow, I have only to read through the review book for the clinical skills test.  I'm not too worried about it, but I don't want to flub it, so I should probably do a minimum of work.

Who knows how the test yesterday went? The stems are long, there's always this sense of frustration at "I know exactly what's going on, but somehow I'm not sure how to answer this damned question," there are crazy pictures of rashes or lesions that cause me to make faces at the screen. The test was long. As I took my lunch break, I saw undergrads arriving to take the GRE.  I'm sure I looked terrible to them: sadly, quietly eating my carrots and sandwich, washing it down with tepid coffee from my insulated mug.  When I got home, I looked in the mirror and saw I had a tiny hemorrhage next to my left iris, probably from staring so intently at the computer screen for eight or more hours.

Afterward, I drove home, somewhat in a daze but less so than after Step 1. I felt empty, devoid of emotion.  It was done, what else can be said?  I met a bunch of girlfriends at a restaurant/bar and the combination of sangria and catching up was enough to lap away at the shores of fatigue. My friend JG and I went downtown to meet up with another friend at her bf's coffee shop after hours, where we sat and drank wine by a fire pit while we told stories about time on the wards and crazy attendings that we'd had. This was a perfect way to end the night: the sharing of tribulations make them funny, rather than tragic.

This morning, I woke up without an alarm, well into morning (at the very the late hour of 9:30!) and just luxuriated in the feel of cool air contrasting against my snuggly-warm blankets.  I plan to just take time for myself today, and do just a little bit of studying.

It's not an "I'm panicking and need to calm down" kind of deep-breathing day; it's a "take a pause and refresh before this last test" kind of day.

September 20, 2013

Bring on the inevitable

Yesterday, I was sluggishly working my way through a few questions and a chapter in my review book.  In all honesty, the effort simply wasn't there.  That evening though, a brief text message exchange with one of my best friends provoked a moderate rush of anxiety.  What if we're not ready? What if we fail? Schools will definitely see our score on this second licensing exam--and even if they don't see it right away, they'll want to see it.  Also, for the sake of being obvious, you have to pass to become a licensed physician.  No small feat to which to steel your will.

I'll admit it: I freaked out a little.  I abashedly texted another friend who's already taken the exam, asking for advice and reassurance. While I wasn't totally reassured by her response (such is the nature of worry, it is not easily quelled by mere logic), I wasn't quite ready to panic and postpone my test.

When I find myself completely at a loss, I long for the ability to take refuge in faith as others do.  It would be so nice--such a relief--to just trust that there is some external force advocating for me!  In the end, though, much as I might occasionally long for such a safety net, I cannot bring myself to believe it exists.

What I do trust in, however, is the power of meditation and the subconscious.  I have found that, when I am truly feeling lost and questioning my decisions, one of the best ways for me to sort through what I'm feeling is to turn to an unlikely source: Tarot cards.  As a teenager, I fancied myself a pagan, and while I never really fully committed to that faith (and no longer really have any faith, as I already stated), there is a central part of me that cherishes the values I established for myself during that time.  Namely, a few core humanist values: the value of all people, a respect for the earth and the environment, a desire to live in accordance with nature rather than against it, a reverence for the miracles of biology that surround us.  One practice that I picked up, though, was reading Tarot cards.  I remember carefully calculating how to purchase my deck; I always received B&N gift cards for Christmas, and I ordered my deck off of the internet.  My Rider-Waite deck has been faithful ever since, coupled with a cheap clearance book on fortune telling (also from B&N).  After several years of intermittent use, I finally have a working knowledge of each card's meaning, so that my readings now have actual use.

As a teenager, I asked foolish questions: does he like me? will I win at the debate tournament this weekend? and I can't even remember what else.  Now, my questions will probably look just as foolish in retrospect, but they feel more urgent.  Will I be successful? What will my career arc look like?  Where will I be in 10 years? Despite the self-serving nature of the questions, I still almost cried with relief when I laid out the spread for my ten-year career outlook: success, victory, reward for hard work were in every position. I don't really feel like reading the Tarot is telling the future; sometimes it seems as though whatever the cards are, you can interpret them to mean what you want them to mean.  So instead, I treat it as a psychological test, an inkblot of sorts, to see where my mind leaps to interpret the meanings of the cards.

Whether it works or not, I always feel calmer afterward; in itself, it is a form of meditation.  I feel more centered, now.  I have to take the test on Saturday and that's all there is to it.  Let the cards fall where they may.

September 15, 2013

And now, we wait

September 15th: the day that ERAS opens, and thus 20,000 medical students across the United States woke up prior to 9am ET to anxiously review their application one final time before hitting 'apply.'

It's scary, but also liberating, to finally have everything in place and to send it out into the world.  All summer, I've been thinking about my application, and my personal statement, and letters of recommendation, and programs to apply to; finally, I could take some action today.

Now I can just check the status section obsessively (to see which programs have downloaded my application) and hope for interviews to start arriving in my inbox.

Good luck to everyone!  As the NRMP website said, only 187 days til the Match!

September 10, 2013

Redemption of a Neglectful Gardener

There is a comforting persistence to a garden.  It will grow, with or without you, given minimal conditions.  If you step away for a few days, or even a week, it greets your return with a bounty that had simply been waiting for someone to harvest it.

The cherry tomato plants in my garden, despite being deprived of regular attention, are still proliferating.  Today's harvest yielded at least a pint of perfect red globes.  Hidden under the leaves of the squash plant were two small zucchini and two large ones, hefty and the length of my forearm.  The basil plants, stretched toward the sun, had put out full, fragrant leaves and the beginnings of flower buds.  Though the cilantro had gone to seed, I still harvested coriander for cooking and seeds for next year.

The magnanimous gifts of my garden, despite its neglect, were a balm for my heart.  This month has been about restoration: getting enough sleep, doing things for myself, cleaning my kitchen, studying for my board exams--all these are a form of meditation, of returning to center. Like going home to find that your mother does, in fact, still love you (even when you forget to call), my garden was there for me even though I had not put enough into our relationship this summer.  Selflessly, the garden forgave me my sins and neglect, and I find myself redeemed and starting on solid ground once again.