One thing that has struck me as odd during my many years of didactic education is the way students view studying, especially intensely, as for tests. We might get cranky because those who aren’t studying are out enjoying life. In college studying imposes quite a bit less than in graduate and professional school (in my experience anyway), perhaps because there’s less studying to do, or because our friends are also studying. Now our peers are working 8-5; their time seems their own. Especially my younger classmates – a lot of my peers have kids to take care of when they leave work, but mid twenties? They’re set. Medical school is not 8-5 (try as I may to make it so). One simply cannot study enough. There’s always more to know, more we could do; we are limited by our mental attention and capacity, willpower, and time.

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.

First, a look back: the holidays were an adventure. We finished up our semesters fairly happy with our grades – Joel did very, very well. I did… well enough. My sister flew in, and after a few Houston shenanigans (read: sitting around), we hit up Garland for more family time and Holiday in the Park at Six Flags. Christmas Eve we headed to Frisco for more family time, then back to Garland, followed by Christmas Day in the emergency room. Joel is now free of his gallbladder. Otherwise a good time was had by all. He handled the surgery well and recovered quickly, and once he was ready for the long car ride, we returned home, anxiously awaited the announcement that my sister had arrived safely in the blizzarding NYC, and got back into our routine. Which brings me to New Year’s Eve. We’re doing a low key family night, and I was just scouring blackboard for syllabi to read, if that’s any indication of what I meant by low key. There’s a whole ONE syllabus, which I’ll begin reading tonight.

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.

Continuing the tradition…

In 2010, I gained weight. Ugh. I’m fixing it. Better news: a new niece and nephew!

I lost my wedding rings. Ooooops.

I stopped doing things backwards when I realized it.

I started investing five minutes to fix the backwards things and do them better. And I started taking brain vitamins.

I was hugely satisfied by many of the ways Zoe is growing and changing. And the way the Street Medicine blue book lecture series went. Oh and a really good run I took with Krystal recently. I actually enjoyed running.

And frustrated by balancing my responsibilities (same as last year).

I am so embarrassed that I got flabby.

Once again, I let my roll get a little too fast.

Once again, I resolved to slow my roll.

The biggest physical difference between me last December and this December is I have straight teeth and my braces are off.

The biggest psychological difference between me last December and this December is I realized I’m 30 and need to think more like an adult.

I loved hanging out with Zoe.

Why did I spend even two minutes worrying about the small stuff?

I should have spent more time being 100% present with whatever I’m doing.

I regret being late to 60% of my scheduled activities. And losing my wedding rings. And being distracted.

I will never regret quality time spent with Zoe.

I worried way too much.

I didn’t exercise nearly enough.

Parenting a three-year-old nearly drove me crazy.

The most relaxing place I went was the Caribbean.

Why did I stress so much?

The best thing I did for someone else was help her understand what’s acceptable and what’s not.

The best thing I did for myself was power through.

The best thing someone did for me was keep me on track.

The one thing I’d like to do again, but do it better, is guide Zoe. (Only one thing?!)

Happy New Year!

(Fill-in-the-blank template from Mary Schmich at The Chicago Tribune)

Are you tired of numbering scratch paper to take practice exams while studying?

I was.

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

Enjoy!

I was just reminded of a few things I may not have written down and should.

1. Today is Tuesday. (Sometimes I feel badly when I ask patients what the date is as part of the mini mental status exam, because most days I’m not entirely sure what day of the week it is, let alone the date. It’s either an unfair assessment of mental status, or I have some deficits.) Glee comes on tonight, and I shriek and clap when I remember this. But no matter what day is it, whenever Zoe wants to bring a smile to my face and joy to my heart, she says, excitedly (of course), “Guess what’s coming on tonight!…GLEE! and DANCING SHOW! [So You Think You Can Dance]” Or if she’s talking to her Dad, she says, “BASEBALL! And the ASTROIDS ARE GONNA WIN!” It’s super cute, especially if it’s obvious she’s trying to create cheerful excitement. Later she’ll ask, “Are you happy?!”

2. I was just describing in an email to my sister a relatively new game we play called “Right in the Face.” It started in the bathtub, though I suppose one could play it anywhere and with other objects. We throw wet washcloths at each other, aiming mostly at the face. The recipient of a washcloth in the face yells, exuberantly, “RIGHT IN THE FACE!” Zoe giggles the whole time – one time she couldn’t catch her breath and her nostrils flared while silent laughing continued, the same way my sister and I do, usually late at night and/or wearing pajamas in the shoe aisle at Walmart. Or when the church choir is recording their holiday CD and it is imperative that the audience keep their traps shut, but some hysterical note was written on the tithing envelope, and laughter ensued regardless. For example.

In the words of Gob, I’ve made a huge mistake.*

They’re called bangs. I’ve had bangs before. And I’ve grown them out. Just when they’re starting to become part of my regular hair, I go and do something stupid like cut them again. It was to encourage me to fix my hair, and also to cover the stubborn forehead wrinkle that has become permanent, despite my best efforts. The onset of post-haircut remorse was record-setting this time. I keep trying for these cuts that look good in theory, and then put on my head, it’s just… not edgy. It probably says more about my face than anything else.

I’m always in hair limbo. In sixth grade I had hair most of the way down my back. Probably not a good look for me, in hindsight. And I was getting headaches, both from the weight of it and also because of the maintenance. So I cut it. To my shoulders. Nothing too drastic really. But the feedback was almost entirely negative. “WHAT’D YOU DO?!” Whatever – I think it looked fine, and I liked the change, but I’ve always been a little hesitant to cut my hair, especially after committing to growing it longer. I love long hair. I think it makes one look more… natural? Easy going? Free-spirited? In the right way, of course. There are exceptions. Maybe those things don’t describe or suit me…

Am I impatient, or do I really prefer it shorter? Post chemo, I had fun with the various stages as it grew, and I think my favorites have been bobs or shorter. I feel like longer hair drags me down. And it ends up in a pony tail most days, because let’s face it, I barely have time to put on clothes, and I value sleep more than looking nice. (I’ll make time for makeup though, or take it with me, because we don’t need running and screaming people in the streets.)

Basically I look about the same or worse, but my hair FEELS better. It was getting krusty on the ends. Plus I needed to catch up with my stylist. The bangs will grow out, and maybe I will have learned my lesson and keep them that way.

Couple this little indiscretion with my recent 10+ pound weight gain, and I’m looking pretty great these days. Most of my 20s were spent fearing what would happen when, inevitably, my metabolism slowed. It was either a self-fulfilling prophecy, or perhaps an unfortunate coincidence, that my 30th birthday was associated with a month-long illness, hindering my workouts, and a more sedentary studying schedule. And of course I love sweets. So 30 for Blake is not hot. But I’ve started back with Jillian and am pining away for the days of less stringent adherence to a healthy diet (I’m not “on a diet” because those do not work and make me depressed), which means I’m trying.

In the meantime, there are barrettes and large clothes.

*If you’ve never enjoyed Arrested Development, for whatever reason, I’m sorry. Because it’s hysterical. Here‘s a compilation video; I apologize for the ad.

We made it through the first block of exams. It was a rough few weeks… I’m still not super proud of all my grades, but half of them were pretty good. The ones that are lower mostly reflect my lack of preparation, meaning there’s plenty I can do to fix it. Which is good. Getting sick right before my birthday was detrimental. And I’m sick again. At the moment I’m waiting until someone at the quack shack clinic can see me for what I suspect is tonsilitis. It’s always involving the throat because of postnasal drip. So I’m starting my allergy regimen again – it’s ragweed season, apparently – and wow this is both too much information and not at all interesting.

What I sat down to say, despite my other, more reflective topics in the queue to write about, is something I realized in the last five minutes: I’m doing okay. In talking to the other student-parents, I’m convinced that despite my extreme guilt at times, I’m spending some quality time with Zoe, and seemingly MORE time than my “peers” are with their kids. Not that I’m competing with them at all – that’s not the point.

Let me say that I love Dads. I love my Dad, Zoe’s Dad, his Dad, and most of the men I know who are Dads are good people. Just to let everyone know I’m no manhater before I say the rest. I’ve said before that it’s easier for the Dads. Dads don’t have the same expectations. They’re typically not the stay-at-home gender (though there’s nothing wrong with that), and everyone understands when they work or spend less time with the kids. Because they’re working. Even in a double income household (whether equal earning or not), more of the kid/home/cooking/shopping responsibilities fall to the woman. The why of this phenomenon is a topic for another time (and I have my opinions). So it’s no surprise to me when I talk to the other students with children that the response from Dads is different than from the Moms. Today I heard, “My kids don’t really bother me that much. I mean, probably because they’re used to me not being around. So when I am there, they just expect me to be working, so it’s pretty easy to get my work done.” Not judging, but WOW. Totally different than my life. From another Mom (of THREE, one of them a newborn; excuse me while I hyperventilate) during exams, “I’m pretty sure the baby’s going through that whole reactive attachment disorder we learned about in behavioral.” She was kidding. On the square. And that’s why I wanted to cry.

My first first year, there were four Moms to my knowledge, and plenty more Dads. Last year there were two of us repeating, plus a new one (the aforementioned Mom of three). In the current first-year class, there is one Mom of two – Zoe’s age and an infant – and maybe a few Dads (I haven’t confirmed that). It’s strange, because from the very first day of school, I saw her and knew she was a Mom. I finally stopped her in the hall a few weeks ago to do the secret handshake and offer support. She needs it.

My school appears to be changing their selection criteria (also another topic for a non-public venue) to those that probably would have excluded me. (Perhaps wisely. I don’t make the scores. But let’s judge ten years into practice, shall we?) Maybe that’s why we’re seeing fewer Moms. Is it a bad idea for women in medicine to have kids? Should we revert to the all-male, paternalistic profession? People make it work – but is the sacrifice too great, on either side? Would I make better grades if I weren’t a Mom? Would I be a better Mom if I weren’t pursuing medicine? Don’t worry – no matter the answer to these questions, or perhaps because of my own answers, I’m staying. If I were going to quit by now, Lord knows I would have. When I get the urge to quit these days, I just pull out the old master promissory note, and that’s a nice therapeutic slap in the face. So the answer is mu.

During the exam crunch time studying, I don’t see Zoe as much, but at the end of the day I know we’re okay. Plus it gives her some extra Daddy-Daughter bonding time. Maybe it’s a personality/viewpoint difference – maybe others have different expectations for themselves as mothers or have maturity I don’t have, and they’re able to focus and study even when they don’t see their kids. Again, not judging. Just a difference. But it’s not what I want for myself and for Zoe. Despite the rigorous demands of these didactic years, my time is mostly my own. I still have to cover the mountains of material somehow, but it’s up to me when I do it. Third year: my ass belongs to the hospital. I’ll be gone for 36 hours at a time during some rotations. So I’m soaking up my time with her while I can, and I’ll find other ways next year.

This may sound like a broken record: I have some a ton of work to do to improve my grades and be more efficient with my study time. It may require crack. But I have a feeling that even when I’m applying for residency and presenting my meager scores, I’ll have few regrets about how I spent my time.

By popular request, I am posting the methods I used to make my dream a reality. Pictures soon. The lemon bar portion is Ina Garten’s recipe. I made the whole recipe, using half to make an 8×8 pan of lemon bars, and the other half for the cheesecake. If you only want to make the cheesecake and not the baked crack that are the lemon bars, then just halve the lemon bar recipe. You can follow Ina’s excellent and thorough instructions for making the lemon bars. The cheesecake filling is adapted from epicurious. One thing, probably the only thing, I will change next time is to make the cheesecake itself more tart. The lemon bars alone are supremely delicious and tart, but against the sweetness of the cheesecake they feel a bit less so. I’ve provided my future plans below.

A word of caution: the cheesecake must be given its time. Prepare yourself to wait overnight for it to chill. Your patience will be rewarded.

Set out your butter, eggs, and cream cheese and go do something else for an hour. (Or, for the impatient or forgetful like myself, “defrost” them in the microwave.) Preheat the oven to 350F. Then make the crust.

For the crust:
• 1/2 pound unsalted butter, at room temperature
• 1/2 cup granulated sugar
• 2 cups flour
• 1/8 teaspoon kosher salt

Cream the butter and sugar until light in the bowl of an electric mixer fitted with the paddle attachment. Combine the flour and salt and, with the mixer on low, add to the butter until just mixed. Put half of the dough into a greased/sprayed 10″ round cake pan (or springform pan, if you like to go to the trouble, but I do not) and press it evenly into the bottom and about a centimeter up the side.

Bake the crust for 15 to 20 minutes, until very lightly browned. Let cool on a wire rack. Leave the oven on, but reduce heat to 300F.

For the cheesecake:
• 3 (8-oz) packages cream cheese, softened
• 1 cup sugar
• 3 large eggs
• 3/4 cup sour cream (next time I’ll use 1/2 c heavy cream + 1/4 cup fresh lemon juice)
• 1 teaspoon vanilla (next time I think I’ll use lemon extract or lemon oil)
• 1 tbsp lemon zest

Beat together cream cheese and sugar in a bowl with an electric mixer at medium speed until smooth, 1 to 2 minutes. Reduce speed to low and add eggs 1 at a time, beating until incorporated. Beat in sour cream, extract, and lemon zest until combined.

Pour cream cheese filling into crust. Now I use a water bath. I place my 10″ pan inside a 12″ pan and pour boiled/warm water into the bigger pan, taking care not to flood the actual cheesecake. Bake cheesecake until set 1 1/2 inches from edge but center trembles when pan is gently shaken, about 45 minutes. (Center of cake will appear very loose but will continue to set as it cools – I promise.)

Remove the cheesecake from the water bath and transfer the pan to a rack. Turn the oven back up to 350F and let it preheat while you make the lemon bar filling.

For the filling (Recall that this is for a whole batch. For just the cheesecake, halve the recipe.):
• 6 extra-large eggs at room temperature
• 3 cups granulated sugar
• 2 tablespoons grated lemon zest (4 to 6 lemons)
• 1 cup freshly squeezed lemon juice*
• 1 cup flour
• Confectioners’ sugar, for dusting

For the filling, whisk together the eggs, sugar, lemon zest, lemon juice, and flour. Pour over the top of the cheesecake and place the pan back in the water bath. Bake for 30 to 35 minutes, until the filling is set. Remove from the water bath and place on a wire rack to cool. Run a sharp knife around the edge to loosen it and prevent cracking. Let cool to room temperature.

Cool completely, about 2 hours, then chill, uncovered, at least 4 hours (or overnight is best). Remove side of springform pan before serving, or if you used a regular pan like myself, flip it out to your hand on plastic wrap, then flip to a serving plate. Dust the top with powdered sugar. Enjoy!

*I cannot support the use of anything but fresh lemons for this. I’m not saying I’ll hunt you down and force you to squeeze lemons as punishment, but don’t complain to me that it doesn’t taste good if you don’t use real lemons. Because it won’t taste good. Been there.

Part of Your World (m4a/mp3)

My little mermaid.

I’ll call it the Bladder Theory*. It’s probably fairly common among busy people with overactive brains; whether the overactivity is causative, correlative, or actually an effect of the theory would be good research. You may be able to diagnose yourself if you’ve ever played the Sims game and gotten overwhelmed. From Wikipedia’s entry:

“The player can make decisions about time spent in skill development, such as exercise, reading, creativity, and logic, by adding activities to the daily agenda of the sims. Daily needs fulfillment such as hygiene maintenance and eating can also be scheduled. Although sims can autonomously perform these actions, they may not prioritize them effectively. Much like real humans, sims can suffer consequences for neglecting their own needs. For example, sims can die from starvation if they do not eat for prolonged periods of time. Needs govern the overall moods of the sims. If the needs are not fulfilled, the sims can become grumpy and unwilling to obey certain player-directed commands, particularly ones that do not fulfill the depleted needs in question. This system follows the Maslow’s hierarchy of needs, in which physiological needs must be satisfied before other needs can be attended to.”

I first played the game when I was 20 years old. (TEN YEARS AGO. Man. Anyway.) It was a short-lived experiment – I found the whole thing very stressful and not too fun. I mean you had to monitor each sim’s stomach, bladder, sleepiness, fridge… You had to send them to the bathroom, queue the tasks of cooking, taking out the trash, picking up the paper… Empty, full, empty, full. It was all the pesky little details of life that if one consciously thinks of them all at once, someone like myself will avoid getting out of bed in the morning. Not to mention that any time you spent playing the game, you were NOT tending to your actual life, so while your sim might be fed and making it to work on time, that real world studying wasn’t doing itself.

When I pause to consider all the irons we have in the fire right now, life is a sims game. Which is ludicrous, and maybe their point in making the game, so we can experience a god-like control over the orchestration of such mundane tasks. I think of this as similar in enjoyment to when you’re sleeping through your alarm, but you KNOW you’re sleeping, and thus the sleeping is much more enjoyable than if you were sleeping unaware.

So there are my actual organs, mainly the food tube and bladder. And Zoe’s. And Chief’s. When we had cats, there were their stomachs, bladders AND litter box. The trash can. The groceries, and not just the groceries, but specific items: at what level is the orange juice? The eggs? The dog food? There’s no room in the freezer for ice cream (needs emptying!), but the frozen strawberries are getting low (needs filling!). The checking account. The credit card. The bills. The laundry. The mail. The email. The air filter. The water filter. The car’s oil, gas, registration, inspection. Prescriptions. Toilet paper. How long since we cleaned the shower? Washed the sheets? Tossed out the leftovers? Joel’s a skilled programmer, and I’m sure he could make a control center with detailed reports on each of these things, which might be fairly entertaining. They should make a game like that. Oh wait.

By the by, Angry Birds is more my speed. Launching psychotic fowl at structures built and occupied by militant, thieving swine is pure escapism, not to mention subtle strategical, physical and geometrical lessons.

When I’m thinking about any one of these things, I’m fine. I do it, it’s done, and I move on to the next item on the list. In aggregate, my head spins. I’ve learned through intense cognitive/behavioral conditioning NOT to think about much in aggregate unless I’m prepared and calm enough and ready to enjoy thinking about it, like contemplating the expansive macro and micro universes. Might not want to do that when you’re trying to go to sleep. Or next time you’re stuck in traffic, look out into the sea of cars. Each driver has a whole story and life and family, and those people have stories and families and lives, and their officemates and cashiers at the stores they visit ALSO have stories and lives and families, all past and present, and we easily might not have left even Houston yet.

It might sound like I’m crazy. And yes, this sort of thinking can produce anxiety. But like the alarm/sleeping concept, if I’m aware of all the balls in the air, yet that everyone is fed, no one has wet her pants, the pets and plants are alive, I still talk to friends and family some, and – oh yes – school work is getting done, I feel more like I’m in a swim meet and less like dog paddling. Which reminds me… I need to work exercise back into my routine. In my defense, I’ve had full sinuses and empty energy reserves.

*Apparently Peter Lynch has a financial theory by the same name. I mean no encroachment.