Today I’m post-call, meaning that I started working yesterday at 0630 and got home (early) today at 0830. So I was kinda tired. Then Zoe had that thing at school yadda yadda yadda we’re just now eating dinner at 2200. Despite our intermittent efforts to plan meals, it came as a bit of a surprise to us after the evening swim that Zoe was hungry. We fed her, finally finished cleaning up the three-days-worth of mess in the kitchen, and looked at each other with the more and more familiar, bedraggled gaze that says, “Does sleep/apathy trump food again? I mean I’m kinda hungry but it’s late and who knows what we’d eat.” I suggested tuna patties, which was met with a grimace.

We surveyed the fridge, finding:
- leftover rice that Joel made in my absence, described with frustration as “not good at all”
- leftover tikka masala – but oh, nope, that’s just the sauce
- leftover salmon – when did we make that? I don’t know. Zoe ate some the other day and she’s been fine, so it’s probably okay.
- leftover turkey burgers – those were great the first time around

As I assembled two small dishes of this abomination, I felt like saying, “This is pathetic.” But I stopped myself. We’re busy and doing the best we can. So I said, “This is resourceful.”

Joel, who provides much comic relief in my life, responded with, “It’s just like your People. We eat all parts of the fridge.”

Things I do like: the hospital. I’m weird but I’ve always liked hospitals. They’re kind of like airports – everywhere you look there’s something to experience, often a deep human emotion that, if you’re tuned in enough, enriches your life in a way you never expected. Turns out there are people who spend their days as bystanders, onlookers, people-watchers at malls and airports and even hospitals – I could have joined them for this experience alone and not tortured myself with medicine, but I think there’s not a lot of money to be made just sitting there, and my family likes groceries.

Plus there are other things I’m enjoying, like my team. My team is awesome. There are five third-year students (MS3 from now on, for medical student year 3), one MS4 (guess what that means), two interns (first-year residents), two residents (one post-graduate year 2, one PGY3), and our attending physician. It’s a large team. If you’re a long time reader you’ll know that I haven’t been my class’s (as a whole) number one fan, but as I’ve gotten to know people I’ve appreciated them more in most instances. I’ll be professional and work with anyone, of course, but I actually LIKE working with these people. All four of the residents and the attending are super, take time to teach us, and are helping us ease into this. My team has figured out a way to make the hours more tolerable, and we work well together. And really, it goes by quite quickly – I’m never bored, for sure. Anyway my team: good.

A few other details (sorry if it’s too much but this is my blog and my memory is bad): once a week we also have a core faculty session with another team and different attending, and so far I’ve learned SO MUCH from these short sessions. Yesterday we focused on the physical exam and everything you can tell about the patient just from seeing him or her, before looking at labs or imaging or anything in the chart. Awesome. I actually prefer to have a little more intensity/higher expectations because I think I learn more that way. Sure, I die a bit when I don’t know um, all of it, but as long as I’m not being personally attacked I think it’s character- and knowledge-building. For example: one thing we do is called Fred Rounds, where a seasoned and very respected doctor who has been practicing for near as I can tell approximately 120 years puts a resident in the hot seat to teach us all important things. The take home is to be precise and thorough and the very best doctor you can be. I’m sure it’s painful, and I was sweating bullets on behalf of our resident. People dread it but I really think it’s one of the best learning experiences we’ve had so far. What else… we go to conference and grand rounds during the week, and those are extra learning opportunities, too.

And of course: the patients. That’s why I’m here, really. Our main job as MS3s is to know everything – EVERYTHING – about our patients. We carry two or three each right now, and our team caps at 20 patients. (Later we’ll have up to five, then as residents oh, ten.) So there’s no excuse not to know absolutely everything about our two. There’s always something else to learn about a disease process or treatment, so I’m doing a lot of reading. We write our notes in the system, and I’m getting that down slowly but surely… All the while I’m adding to my knowledge which I hope will help when I take my boards – this year we take the internal medicine shelf exam after only two months, whereas in the past there have been three. Frightening. I need to study more. But already having a patient to associate with everything I’m learning really helps me retain it.

The only person being mean to me is this girl named Blake. She just won’t let up! Her expectations are ridiculously high. I mean, we just started, and she’s acting like we have to know all the answers already. She tells me my grades and scores are bad, that I’m not doing as well as everyone else seems to be doing, that every time I speak I’ve said something embarrassing, and that I shouldn’t even be here – there’s no way I’ll make it, and when I don’t, my daughter will be angry with me about all the time I’ve missed. She always has something critical to say about me, and I’m tired of her negative attitude. STEP OFF, B*+CH. Plus she’s really crabby when she doesn’t get enough sleep, and between you and me, I think she’s insecure and anxious.

Other than that B, shortly and sweetly, the main problems are exhaustion at times, and the runaround. The system. The frustration at the larger forces at work. The claustrophobic feeling I have when I consider the human condition. Being sick…SUCKS. I know first hand. I think that is the true soul-sucking part – I have the unfortunate awareness to realize that there is no way to avoid suffering in this world, and some people have more of it than others, and sometimes we can’t do anything about it. You guys, death is not the worst thing that happens to us. My heart aches in these cases.

Oh and presenting. I’ll get better at it – I know I will – but DAMN I’m bad at it. I want to melt into the floor and erase everyone’s memory every time I speak. Sometimes I know answers, and sometimes I even say them aloud. But when I have to present a patient – summarize their condition and spout off all pertinent information, including lab values that should be memorized – I tank. TANK, I tell you. It’s terrible. I’m getting sweaty just typing this. Ugh no more.

I’m making a conscious effort not to focus on what I don’t like. Because this is my life. It WILL get better. I’ll get better. I just have to take it one little bit at a time.

In other news: Zoe and Joel seem to be holding up well in my relative absence. Right now Zoe is entertaining her Cap’n and Gigi in Garland – she had been begging to go see them, and I’m really happy it worked out. I love that she loves all her grandparents and talks about them often. There’s a lot of love here.

A curly-headed blur zoomed past me as I carried the dog’s full bowl of water to his tray. Zoe, don’t run with a pen, please. It’s dangerous.

“It’s not a pen, and anyway I was skipping with it. It’s my pencils.”

ALRIGHT WELL WHATEVER YOU’RE RUNNING WITH STOP IT AND WALK – you don’t wanna put an eye out.

Yeah I said that.

This comes on the heels of her very first stitches Saturday night. She was refusing to eat dinner with us during a half hour of being an utter pill for an unknown reason, most likely that she was tired after a long day of doing

Hold on. I just had to save this draft and return to it because there was a crash in the kitchen. It seems someone had climbed up and gotten plates to set the table for tomorrow morning’s breakfast (SUPER SWEET right?) and long story short we have one fewer plates.

Where was I? Oh yes, the stitches. So in a fit she shoved off our lofted dining table in her lofted pink chair, which fell back in slow motion. I said, “Awesome,” as she fell, because I was thinking that surely THIS would teach her, not injure her, but scare her into thinking at least twice before her next display of stubborn hostility, when she landed, quite gracefully, upright and without any limbs under any part of the chair. Whew, I thought, but in just as slow a motion, unfortunately as an aftershock of the landing she bumped her chin on the padded part of the chair and began crying in pain. Joel picked her up and brought her to me, in his infinite wisdom warning me to hold back the I TOLD YOU SOs until we determined she was okay, when I saw blood gushing from her chin. After we stopped the bleeding I got a better look and could see muscle fibers and adipose tissue coming through, so off to get stitches we went. To me, lacerations are the worst – I mean, to look at or even feel the chair, you’d never think it would break skin.

The urgent care place was awesome. We were in and out, they numbed her well, the treatment team was really nice, and although a white sheet papoose/taco was necessary,

Wait so I’m not making this up. She just came in, wide-eyed, and said, “Mom, you better not step on all the towels because I spilled a WHOLE BUNCH of water.”

Right now you might be thinking many things, such as why isn’t your four-year-old in bed? And why are you continuing effectively to ignore her, and where is your husband? Exactly. Now they are playing something called fishkitball and I’m going to wrap this up.

So the three stitches come out in a week. A week during which she can’t be in the pool. During the last week of her swimming lessons. But we’re so fortunate that these are the worst of our concerns regarding her health.

In other news, third year has begun, and I’m really excited. More on that later, surely. Today during orientation attention was paid to our responsibilities and cautions regarding any online presence we may have. I like to think I’m aware of these issues and walk a fine line both personally and professionally, trying to balance privacy with creativity and honesty. It was a good reminder never to betray the trust of the people for whom I’ll be caring medically and with whom I work, and I also thought about Zoe. I hope she doesn’t mind and maybe even will think it’s cool to have grown up online. I know we’re taking some risks and that not everyone would do it this way. She knows I write about her and post pictures of her; if anything I just want to share the joy she brings to our world, even when she’s breaking skin and plates.

Have you ever spent a week away from your child? Because I hadn’t. I think the longest we’ve been apart approached 5 days once, until this time. The first couple of days I did a lot of milling around and not sleeping – put it on my tab – but was able to put about half of those extra hours toward studying. They return tomorrow, thank goodness. Every Mom yearns for alone time and lots of space to stretch out and be comfortable and do whatever she pleases. Did I appreciate the opportunity? Yes, and I’ve been productive. But I’ve grown accustomed to their faces and am disoriented without them here.

In their absence, Chief has stepped up been here to receive my extra love and ramblings. (BTW, I still can’t believe this happened.) We’ve gone on long walks with Goljan audio and frequented the dog park. New landscaping has meant water runoff into the dog park, creating fantastic mud pits for wallowing. So we’ve had a few baths. Confirming Joel’s suspicions that his main objective in life is to be in everyone’s way, he has avoided the bed for all but a few hours the whole week. Without Joel’s long frame to impede, what point would there be?

Enough of my lonesome musings and avoidance of First Aid. I gotta make today count!

So. Wow. What a month! April 15 began a marathon stretch of block 4 exams and finals. We had one every other day until this last Friday. It has been thrilling to be a human for the past 36 hours. Even better than being done with exams is that I PASSED. Comfortably. There are two grades left to be revealed, but I have no concerns – I am proceeding into the clinical years of medical school. I’m so excited. For me, this has been a long time coming, fraught with obstacles, most of them of my own making, which has been well-documented here and on twitter. I’m SO my own worst enemy it’s ridiculous. I’ve learned a lot (science, clinical skills) that will carry me into this next chapter of my education, but perhaps the most important long term is to quit giving myself such a hard time and focus on what’s important. I’ve heard that from my loved ones my whole life. I’ll probably have to relearn it about a hundred more times. But any energy I spend not encouraging myself is wasteful. And I’m forever grateful to the people who manage to cheer loudly enough to drown out all the deconstructive l noise. What else helped: taking care of myself, getting as much sleep as reasonably possible, and not to sound like a kook, but vitamins. Brain vitamins.

And so we continue. As mentioned previously, I’ll be studying for the USMLE Step 1 exam from today until June 9. Related: my school is awesome. Many of our finals were national board exams, and for the most part I feel like our classes were good preparation for them. I have a ton of work to do before the step exam, but the basic sciences curriculum has given us all a good foundation going into it. And schedule-wise, the second year was WORLDS better than first year.

Zoe really maintained patience with me during the repeated Mommy-has-to-study-nows and the just-a-little-bit-longers. Only one more month now. June 10 will be a glorious, glorious day. Zoe and I are heading to New York to visit Aunt Ft, who will be fresh off a giant exam as well.

Rotations start at the end of June, and I got one of my top choices of schedules. I probably don’t even know what I’m getting into, kind of like before I started first year, but I can hardly wait.

Thursday night we had Zoe’s friend over while her parents went to a concert. I decided pizza was a safe bet for the evening, given that I still needed to study a little bit. We determined that Zoe’s friend and Zoe preferred cheese pizza. They began eating a red bell pepper appetizer while playing a computer game, and continued playing during pizza. This was the other little girl’s second dinner, and she’s thin as are many six-year-old girls, and I figured she wouldn’t eat much. I was wrong. Each time she requested another slice, Zoe exclaimed, “Me, too!” Glasses of milk were poured. About the third slice, Zoe had slowed, and eventually her friend ran out of steam on her fifth. (For reference, they’re small pizzas, but all four adults in the house stopped after 2 or 3 slices.) Zoe had a half glass of orange juice. The two played a little more, and after awhile we got into pajamas and read a story in the princess tent. It was a good night, and when the other parents returned, goodbyes were said. I noticed Zoe’s face was red, but I thought it might have been the running around. All in all, it was an uneventful night.

Until about 15 minutes later. We were in bed, playing Plants vs. Zombies per usual, and an uneasy tense feeling came over me. The girl was going to vomit. Within 10 seconds, she coughed and covered my top half in chunks of pizza and red bell pepper. We made it to the bathroom, where she finished the job on my bottom half with two more enormous, projectile vomits from 3 feet away. She was largely unfazed. We bathed, redressed, tossed a blanket on the bed, and got situated again.

Joel had come to bed at this point. He was expressing his concern, consoling her in a way, and gave her a kiss or a head tousle, which disgruntled her enough to say she didn’t like him. I told her he loves her and is good to her, that it’s not nice to say such things and at least to give him a chance.

“But I don’t love him.”
Oh, Zoe. You do somewhere in there.

As if to counterpoint, she coughed again and covered him and his pillow. Again to the bathroom, and again two more vomits; the first was epic, and she stood there in her tiny Hello Kitty briefs staring, almost in awe, followed by a small tribute vomit. Another bath (with Dad this time), and another scavenger hunt for something to put on the bed. A tarp was considered. Fortunately she must have gotten it out of her system, because, after a discussion of the physiology of emesis, we slept soundly . At least until my alarm blared at 5. (I am officially too old for such short nights.)

Nana did so much laundry that night. When I left for school, she was passed out on the couch and blankets were drying. (Thank you.) Zoe milked the previous night’s “illness” for a day at home but had no further vomit. I really thought kids were better than adults at stopping when they’re full. In retrospect that was a LOT of salt for a tiny body, and I should have been more aware. Live and learn.

So halfway through our flat, the brush stopped spinning. I excitedly gathered the appropriate tools to investigate (including a special screwdriver I was THRILLED to find among our possessions, from a tool kit given to us as a wedding gift – that thing has rescued us more times that I can count); sure enough, the belt had snapped, and shortly I was on the phone with Dyson for a replacement part. Their customer service is awesome, a rarity these days. During the call I had the opportunity to clean the brush and was unable to stop debridement until I could no longer take apart the machine. I look forward to seeing if my love of this kind of work carries over into medicine like I think it might.

Fortunately the vacuum is still under warranty, and a new belt is on its way. In 7 to 10 business days. HOMER SHRIEK. I may have reassembled the vacuum and dragged the non-brushing, for-hard-floors version over the carpet to give myself the impression of vacuum lines. This wait will not be a problem. I’m fine. < freezing cold sweat >

Many of us become theives, stealing time and energy that might otherwise be devoted to exercise, home organization, preparing healthier meals, or fostering relationships with loved ones. Or just garden variety down time – relaxation, escape. (Then we swing the other way and it becomes the studies that suffer.)

I hear a lot of complaints that med school ruins social lives. “I never go out anymore,” or “My significant other is so frustrated that I don’t have enough time for him/her,” or “I just feel so isolated.” As I was discussing with a fellow student today, I think this aspect is easier for me. “Going out” never has been part of my life – to me the whole thing is more anxiety-provoking and exhausting than anything else I could be doing. Relationship-wise, my family and friends understand what I’m doing, and we talk when we can. Joel and I spent most of our courtship in different cities, sometimes states. He’s really busy, too, so we understand when there’s no time for a cutesy heart to heart. This is also where being married/living together has advantages. If we had to schedule a date amidst our other activities – forget it. If we weren’t established and were trying to nuture a budding romance, I can imagine the difficulty to find time and energy for that. So I do feel for my dating classmates, if it’s something they’re missing. As far as isolation – I like being in my own little community – school is my escape from what I consider the more stressful day-to-day life. But if I didn’t have my Zoe and Joel and Chief, I know I’d be terribly lonely sometimes.

Anyway I would hear these complaints and just didn’t comprehend. I don’t feel pulled to bars or parties. But then I think about how I do spend my spare non-studying time. I do feel pulled to zoo outings with Zoe. I need zoning-out-walking-around-Target-or-the-mall time. I look forward to well-prepared meals and television shows the way my classmates might anticipate a hot date or some other debauchery. So when I spend more time studying and these things get put on the back burner, I feel the stress. Forgive me for having been judgmental about how people restore their souls. And it’s not like I’m some zen master – maybe I could learn a thing or two about letting go.

When I was making the decision to apply to med school, I weighed my desire to have a family very heavily. I wanted to have enough time to do it the way I envisioned parenting: being there, being engaged and involved, having real time together. Perhaps my reluctance to develop and adhere to a rigid schedule is from fear that we’ll become this super efficient family who does get everything done but it means that we come home, make and eat dinner, get a bath, get in bed, and never really engage. So we hem and haw and stay up late… There’s probably a middle ground.

Anyway I looked at my friends in med school and saw they still had lives, still went out, and figured if that wasn’t something I would do, certainly I had time for my family. You spend your time. You make and find time for what’s important to you. Sometimes priorities get changed temporarily, but in the end what you value gets your time. We have agency. That’s true for 8-5ers, stay at home parents, and students with jobs. Our time actually is our own, and we are choosing how to spend it. (Especially as med students. When we get to rotations and residency and competitive jobs, we are owned for awhile – thought it is a choice we make.) How we spend it reflects what we value. Lately I’ve been trying to realize this and own it – be honest with myself about what I’m choosing is important to me.

Most of it seems so external – deadlines, pressures from bosses, coworkers, family, friends, our children, “the schedule” – but we have a lot of control over what we deem important. Yes we have to make money to pay for things. When we work to cover our rent/mortgage, groceries, and car payment, we are valuing shelter, food and lifestyle. We are choosing those basics/comforts over the stress of being homeless or hungry. (My perspective falls apart when someone is working three jobs, not sleeping, and still has a hungry family – I hope this doesn’t happen.) Being honest with myself, then, I’m choosing these years of taking out loans and having Zoe in daycare to have the career I want and the happiness that fulfilling work will create for me and – please please please I hope this happiness will extend to – my family.

In a related story, when I select my categories or tags for posts, it seems silly to select life, health, family, and school separately. Because that’s what all these are about. They’re synonyms at this point.

The last couple of days I’ve been a little irritable, mostly thinking about how hard the next six months will be. But now it’s more excitement as I nerdily read the topics we’ll cover this semester. Plus – GET THIS – it’s my last semester of traditional classroom learning. Glee. In July I’ll start doing what I came here to do. THAT’s exciting.

Now until then, I will be working diligently. Fervently. Choose your adverb. For I am in hot pursuit of a STEP 1* score to balance my mediocre grades (in addition, of course, to maintaining and improving said mediocre grades). So. It will be med student business as usual (meaning I belong to my studies and Zoe, attempting to maintain sanity with acceptable down time and leisure activities) until May. In May I begin living in a cave with test prep materials and sustenance until I have taken my test (a TBA date in early to mid June). Please understand if I appear to have dropped off the face of the Earth or decline participation in significant events during this time. I mean no disrespect. All the love in the world to my family and friends who are supporting me through this journey.

I hope everyone has a safe and happy start to 2011!

*For anyone unfamiliar with the STEP 1, here’s some basic information. It’s… kind of a big deal to me.

I was.

So I made these: [excel version for making it your own | pdf version for quick printing]

Enjoy!