A savory morning.

There’s something about a morning in which you don’t need to do anything, isn’t there? This morning, freshly returned from a trip out of town, I didn’t set an alarm. M brought me coffee around and I slowly rose, sipping it along with some blackberry yogurt while I finished an episode of a reality television show I had started last night, before my family called and told me to come watch my little sister played softball. I was reading a bit when I started to get the itch to get moving.

We were out of town since Thursday, in Jacksonville for the US 15k Championships. We spent the next few days camping at Little Talbot Island State Park, taking advantage of my spring break. It was pretty glorious–a few days in a nice (free!) hotel room, lounging at the rooftop pool, having drinks with M’s runner friends. And then the park–oh my beautiful. We somehow managed to score the best campsite two days before our trip when someone cancelled, even though the park was booked up for months. We pitched our tent underneath palm tress, which framed the view out over the marsh, where we could sit, sip wine, and watch the birds and the sunrise. There were these perfect secluded beaches lined with forest and covered in petrified trees. The weather was absolutely perfect–bright and sunny, in the 80s with a breeze. We ducked into a small town up the road to stroll along the boardwalk and eat the world’s best lobster rolls on our last night there. It was blissful.

I actually got a shocking amount of work done. Spring break seems to be the last marker in time for people–even my friends who hadn’t started studying for Step 1 said they would get at it after spring break. That made it seem very real to me. It also, it seems, is suddenly almost April, which is the month in which we finish classes. After that happens, it’s real dedicated study time. That’s terrifying. So with those thoughts as my motivation, I carried my Step 1 Secrets book with me, catching up on the chapters I had fallen behind on, scrawling the information in my copy of First Aid so I can review all these high-yield facts over and over again come April. Between my free time on the flights and at the pool and on the beach, I was feeling pretty good about the number of chapters I was able to get through.

I was also, though, glad to get home on Tuesday of spring break, giving me plenty of time to regroup and hit the reset button before school gets going again; thus we come back around to this morning’s restlessness. I have a long list of things I want to get done this week, and I suddenly felt the need to do them all at once: I want to get to the gym and get my workout over with so that I can study this afternoon and maybe I’ll get to the grocery store and I just have to get through this review set today and on and on and on…

about there was where I reeled myself in. Mornings, when you have them and can let them unfold slowly, are these savory wonderful things that can make the day less exhausting. So I started another cup of coffee and set to journaling, making some lists, sitting in some quiet time. I let myself have time to catch up on writing. And I will even take some time for a bit more television, letting my tension unwind a bit before setting about the days tasks. My workout can wait until this afternoon, when the weather is warmer and I can stand to be outdoors. Shouldn’t I be getting outside more anyways? With a whole day free, there is not rush to get to my to do list. It is written down and I know what I need to do and I will do it. After I enjoy my morning.

Oh, I will become what I deserve.

In the midst of block week (why am I on the internet doing something non-academic?!). Poking my head up into the world from here, on the couch, in my “100% Real Baby Alpaca Wool” (one time, M and I went to Peru and were willingly scammed to purchase big thick sweaters to keep us warm while we slept in a field during Southern-hemisphere winter…but that’s a story for another day) sweater that I haven’t taken off since Sunday and my yoga leggings that I probably won’t take off until Friday night, despite everything that is good and right. Block week is, in a few words: minimal leaving this couch, minimal cleaning, minimal showering, minimal care for what I look like. And a free pass that makes all of that acceptable.

Last block week, near this time, I had a quiet breakdown. I sat in an armchair and stared at the wall and muttered some nonsense about not learning anything despite all this work. I felt exhausted and used up and at my wit’s end. That little episode ended in me taking a break, watching an episode of the Mindy Project, and eating Arby’s M brought home to me, complete with surprise cherry turnover that my Block Week brain kept me from discovering until the next day.

This week, I have a thought that keeps creeping in that I shove away: I feel like I’m almost ready.

Ok, that would be nuts because it’s only Tuesday. Not letting myself off the hook that easy. But I feel good. I feel like I know stuff. I am wanting to chalk it up to a few things:

1. Gastrointestinal is easier than Cardiopulmonary. It just is. Intestines are simpler than your heart and lungs.
2. This block contains only 3 weeks of material, the shortest thus far.
3. Conscious efforts. This, for me, translates into morning prayers and daily runs or yoga and taking the very small steps like rinsing a dish, for heaven’s sake that can keep my apartment in a reasonable, if not clean, state, while not eating up my time.

So I’m still working, but in a slightly slower, more relaxed way than I felt I needed to before.

I am excited to bring you more tales: a really heart-wrenching visit to The Healing Place, a very cool rehab center we have in town, and how my amazing husband WON a marathon and the schmoozing and politics of the desire to be a surgeon and how I almost got to Kenya but then didn’t. I’m not so sure of myself, though, that I can share that all now. Until post-block, dear friends.

Pressure and practice.

The way my medical school’s second year curriculum is set up bodes well for those of us that perform well under pressure. I, thankfully, fall into that category. Easily. So much so that I am constantly outperformed by others on easy things that everyone should do well on.

So Block Exams are great for me (and I again did quite well), because I love the intensity of a high stakes situation. I love waking up on the morning of what I think of affectionately as Game Day after having done everything I could do to prepare. I love that the exams are all interwoven into one giant adversary, and that I have one go to defeat it. I kind of love Block Week. It’s sort of miserable and the stress is palpable and thumbing through your notes that many days in a row makes you a little crazy, but I love the Friday night prep: sitting down at my desk, writing out everything that I could possibly need to do to learn a huge pile of content like the back of my hand, making motivational signs and battening down the hatches for a week of no cooking or cleaning, no resting, no messing around. I love knowing that it will take everything I have, and the week long challenge to give it. I love the feeling of walking away from a five hour exam, knowing that I crushed it.

Not everyone in med school feels this way. They are grappling and struggling and torn about what to do, now having been through two block exams and not feeling that feeling that you get when you crush it. They don’t get that post-block weekend of blissful freedom because they’re already trying to regroup for next block; to figure out how they might save their second year of medical school. Because no one wants to end up (gasp) a repeater.

Pressure doesn’t bolster everyone like it does me. It does some in. I don’t know what to do for those friends, except quietly nod as they tell me their troubles and offer some sort of sympathy. I feel for them, but I don’t know what to do.

I suppose if I’m giving anyone advice about any part of med school, it is simply practice. It sounds too simple, but that’s all there is. Practice recalling information and you’ll be able to recall it when a question appears on an exam. Practice physical exam steps and you can do them without thinking. Practice studying and you’ll get really good at studying. The pressure won’t break you if you practice. It takes so much time—an unreal amount of time—because you’re adding new things everyday, and so your list of things to practice gets longer. And some of it is complex, so figuring out how to frame it and fit within what you know already and how to even begin to know it in any permanent way is difficult. But all you can do, no matter the amount or the complexity, is practice. Over and over and over again.

I find it interesting that what we are all working towards is having a medical practice: it never ends. It’s a practice in the same way that my daily yoga is a practice: doing everything you already know how to do, a little bit better than yesterday, and adding new things on all the while. Discipline and repetition exist alongside expansion and growth. Where we really start to learn is in the hospital, where there are real patients on which we can do physical exams and diagnostic tests. We can learn what medical problem they have and what we need to do to help them and we remember them, because they are patients and not words on a page. It is this practice of working through the whole process—from hello to long-term patient outcome—first, under other doctors, and eventually, on our own—that makes our practice of medicine deep enough and whole enough that we can contribute to a person’s health. It’s a long way off, sure, but it’s a great goal, isn’t it?

Block Week

Climbing out of bed to a faint, early morning wake up call. Bare feet on cool wood floors to the coffeemaker. Distant mumbles as a husband rolls over and drifts back to sleep, alone in the middle of the bed. A few moment on the couch in quiet, breathing in the darkness, hands wrapped around the warm mug. A hard stare at the page taped on the wall above my desk:

“You wake up early and you work all day. That’s the only secret.”

And so I begin. Online clinical cases, handwritten notes, labeled microscope slides, drug flashcards, tables and table of bacteria, viruses, fungi. Five days of 5:30 AM to 10:00 PM. A belief that this will be enough, but only just enough. Focus, determination, discipline, and a lot of prayer. This, my friends, is Block Week.

Motivation Saturday.

I want to be a surgeon. For as long as I have wanted to be a doctor, which is since I realized that it would be cooler than working on Mission Control at NASA, I have wanted to be a surgeon. This morning I got an email from the American Medical Association with a new report on residency rankings by specialty. These are the programs that I dream about. And my husband, too—he talks about living near the lush woods in Seattle or settling near a fireplace up in the mountains of Denver or running on a wooded trail along the coast in San Francisco. What I want, and what I feel like could be just barely within my grasp if I push, is to have my pick. I don’t know if I can do it, but I dream about it, and I want it with all my heart, and I am going to try.

So its Saturday. I’m going to find a coffee shop where I can focus and work through: bacteria and viruses that cause respiratory infections, cardiac and pulmonary pathology, all of the drugs that treat them. Combing through information, applying it in clinical vignettes, and practicing. Always more to practice.

Also I’m watching an old Grey’s Anatomy in the background and one of the interns just shouted, “I want to be in charge of my education!” So I’ll do that, too.

“The impossible only takes a little longer to achieve.”

“So let’s talk about how you end up at a hospital like Massachusetts General. Do you read the New England Journal of Medicine? You should. Oh, and obviously, you have to crush Step 1. That’s just a given. Start there.”

So much of my current, medical school-driven life, has been changed by my summer at MGH. It’s not enough, anymore, to just be ok. It’s not enough to learn the high-yield facts and forget the rest. It’s not enough to skip Intro to Clinical Medicine (because how important could it be to understand how to develop a differential diagnosis. Answer: very). The small things, I have seen after being in the OR and on the wards, are what add up to make a great doctor. And it’s most certainly not enough to just take what’s on the Powerpoint and memorize it in order to do well on an exam when the information on the Powerpoint doesn’t actually help you understand the material. Our Pharmacology program is, by anyone’s standards, very weak. I have heard this, but coming in and sitting through the course director’s first few classes, I loudly and unabashedly concur. It’s a string of vague, overgeneralized statements about drugs that we are expected to know how to use. I’m sure the man is smart, but he is not giving us the information or teaching us the concepts thoroughly enough that we can grasp them. I expressed to another student the other day that this man might be one of the worst teachers I’ve ever had, and she replied, in shock, that he’s giving us everything we need, since he promises that the questions on the exam will be 100% from his Powerpoint. “I think he just doesn’t want to give us too much information and bog us down when he doesn’t expect us to know all that.” Another student added that he doesn’t see the need to teach us what we  use the drugs to treat because he won’t test us on that.

If you’re like me, your eyes are currently as big as dinner plates and your jaw is on the floor, and you are internally shouting, “NO! Bog them down! They’re going to be doctors! Of course they should know what we use the drugs to treat!” I know, I know, it seemed crazy to me too. So after much consult with an older student that I trust and some strategic online med school warriors, I have abandoned ship and switched to Kaplan Pharm videos. Here is a wonderful teacher who has taught me all the wonders of Autonomic Pharmacology, with a charming French accent, no less. I am unashamedly taking control of my own learning. I will not be the normal student at my school, moaning and toiling at how horribly something is taught, and then continuing to study it. I am going to learn as well as I can, and if that means finding new sources, then so be it.

And that brings us to Block Week: the ominously, eerily empty week that comes around every month or two during second year. On Friday we will have our first block exam, an beast of a test, hundreds of questions, that consists of all of our subjects mixed and mashed together with no identifying features. Allegedly it helps prepare you for Step, which looms at the end of second year. So I sat down yesterday and developed a schedule, thinking it would casually prepare me for a more organized week. I listed my courses, the topics covered, the resources I wanted to consult over the course over the week, and the hours I expected each to consume. And before I knew it, I was looking at 100 hours of work. Well, I logically thought, I don’t have 100 hours. So I trimmed. And then I had 88 hours of work. Then I started to look at the hours I could realistically keep—I’m a champion of balance, even during block week, to some extent—so I gave myself 8 hours off each night plus an hour to exercise during the day, setting my working hours at 6 AM to 10PM (I know, I’m dying at the sound of that too, but I have my inspirational quotes to drag me through it). So a quick calculation tells you that I also don’t have 88 hours: I trimmed again. The result is 74 hours. 74 hours of work to get me through all of this material, to practice questions, to learn to apply concepts, to draw diagrams and memorize drug names. On Sundays, it is my custom to rest, as I believe that God is incredibly smart and came up with the Sabbath for a reason, even if we don’t always see it. But on this Sunday, Block Sunday, I know I can’t afford to lose all of my hours, so I’m having an abbreviated Sabbath and will put in 6 hours after church this afternoon. Where I will pray, very earnestly, that I will survive Block Week, and that all this nonsense will be worth it come Friday.

 

The value in our days.

My weekend: I still can’t figure out if Saturday was worthless or something its way to worthwhile. I studied at home, which is inherently not worthwhile, because I take 20 minute long Grey’s Anatomy breaks every hour…or more. I’m horrible and have no self-discipline. I spend the day toiling through pharmacology, completely unsure what to do with it. I have a pretty solid study method that I apply to everything, which, if I am religiously faithful to it, works like a charm for me. But here, I felt like I was writing fact after fact with no understanding (because there’s nothing to really understand) and I was just melting into a puddle of distraught lack of knowledge. I was just bursting for a Sabbath by the time Saturday night came around, and man was it great: sleeping in, apple pie oats for breakfast, church, beet salad with goat cheese, laundry and errands, thank you cards to MGH, television, a nice steamy run and strength workout, and finally FINALLY getting our clothes off of our bedroom floor and into the closet. That may not sound fun to you, but as someone who walks through her bedroom to bed just deeply dissatisfied with how her bedroom looks every night, I was overjoyed to have the time to sit by myself, folding laundry, watching Grey’s Anatomy, and making my room feel a little less claustrophobic. 

Today, we were gifted with a day of no classes. No idea why: it honestly feels a little ominous, but imma go with it. My friend and I held an Immunology Summit (don’t ask why because I honestly don’t know why we called it a summit), in which we tried to sort out all of those cells. We had some success, but it could have been better. That, perhaps, was the value in today: to know that next week, during block week when we have seven straight days of emptiness bound for studying, we need a plan. That, after all, is where success starts. Or something like that.

The other value of today came from sitting with a sweet friend over a tropical smoothie in the (rather extreme but still glorious) sunshine and talking about our summers and boys and how weird med school is. I think that’s what we all need most sometimes: to sit and say, “Man, this is weird.” It makes it seem more normal. Or something like that. 

What I’m saying here is that the value in our days is self-defined, and it should stem from what we want. I want a clean bedroom, so my Saturday was super high yield. Today, I want to learn neuropharmacology, and I am trying—trying—to make that happen. Saturday I maybe didn’t pull that off so well. Its an interesting balance, because maybe we want to sit around and watch Netflix, in any given moment when we’re a little sleepy. Or maybe we want to sleep late or eat macaroni and cheese every single night for dinner (true confessions). But there comes a point when your dreams—to be surgeon, and one who doesn’t weight 300 pounds, at that—don’t coincide. To a certain extent, it’s about what we need, and to a certain extent it’s less about what we want in this moment and more about what we want to be, at the end of the day.