Waffles; they're not just for breakfast anymore!

I keep waffling back and forth between feeling as though I am going to be the best doctor ever and expecting the big Gong Show cane t.m. to pull me off the stage. My class nominated me for an award. I'm in awe - partly because I'm pretty sure other people deserve it more, partly because I didn't think anyone noticed that I was there. There's a dollar amount attached to the award, so it would be fantastic if I actually win the thing.

I've decided that observerships are the best thing a med student can possibly do. I arranged to shadow a rheumatologist this week for an afternoon in her Osteoarthritis clinic. Her nurse was confused about my qualifications (thought I was a resident i.e. already an MD) and started barking orders at me about what I was to be doing all day. Given that I've covered OA in school already and feel comfortable taking patient histories from all the clinical methods training I've had (6 weeks) I was OK with it. When the doc showed up, she knew I was still in first year and didn't give me anything I couldn't handle. I was essentially catching patients' files up since their last visit by getting their histories (solo), interpreting x rays and learning a heck of a lot. Don't worry, the patients all knew that I'm just a student.

I left the OA clinic feeling like I could be a doctor right then and there!

Then I started studying again.

How is it possible that I can be so far behind when I work so much? I think I set my expectations for studying way too high. Re-writing every single lecture is too far. Ignoring weeks of material because I had the prof isn't far enough. Where is the balance they talked about in our first week?

Something I haven't mentioned yet is what I have going on in the background. I find it to be a struggle to keep up with what is going on in my home life and my school life. My partner has bipolar disorder. It's type II which means it's a mild version of the disorder, but that's not reassuring when I never know what to expect when I come home. I don't have the support here that I wish I did. It's not something that I advertise either, I don't want people to know what I'm dealing with. I'm not sure why I think it matters - probably just that I'm not ready to expose my weaknesses until I really get to know my classmates. He's on meds which is fantastic and tries really hard to be stable for me. No extra pressure at all. But if I can get through med school while dealing with his insanity (literally) I deserve then M.D. I'm given.

I guess I'll just keep trudging through until the cane pulls me off the stage.

Lots of information, not enough neurons

AHHHHHHHHHHHHHHHHHHH!!!!

Midterm is next Monday, Finals start the week before Christmas. The first final will be fine but the next 3 I haven't begun to prepare for.

I'm still going to do observerships because that's where I feel I learn more about medicine than I ever do in lecture.

My last was with a hospitalist who let me do rounds with his residents. I was taught to do some tests and was included in conversations about the patients' care. I can't believe it's taken me so long to do these!

My next is a psych observership which I'm really looking forward to. I'm not sure if I want to be a psychiatrist - in fact I'm not at all sure I know what I want to be, but it will be great to learn what they do. I think that no matter what practice I end up taking up, there will be a psych component to it. Same as regardless of which practice we choose, we're all going to be geriatritians. As I go through my class material, I try to think about how what I'm learning is different if the patient is old. Should be good practice right?

One of my finals is MSK (musculoskeletal) so I've arranged for my observership before finals to be in the osteoporosis clinic. It'll be like review for the final right??

The more I think about finals, the more I freak out. It's a lot of information for me to have in my head and be able to apply clinically. Clinical application is fun but requires that I really own the material.

Which means I better get back to work and stop watching Bones.

Prejudice is a four letter word. No really, count again.

Prejudice is live and well in the medical community
:: waits for the shocked gasp ::

One of my tutors firmly believes that everyone has equal access to health care and that Americans are well off with respect to wait times and ability to get care. I get so angry. Then I blather on and on about other things because I know if I don't change the subject I'm going to punch her in the mouth. She goes on and on about the 350lb man with a donut in hand who comes in complaining of >insert whatever illness we're discussing that week<

She also assumes that people who work blue collar jobs are a) idiots that aren't capable of understanding a treatment plan and b) don't care about their health.

If Canadians, rich and poor, have equal access to health providing opportunities, then why are babies born to teen aged moms significantly smaller? If it's not the reduced counselling about prenatal nutrition received compared to women in their 20s and 30s, and the lack of medical support for this demographic, then I just don't know what it would be.

I recently came across this blog called "First, Do No Harm"
It's terrific, horrifying and well written. Fat people who have been treated like garbage talk about their experience accessing health care in the US. I know it's the same here just listening to my tutor.

Checking in

After being so worried about my first block exam (and the gong-show of disasters that surrounded it) I ended up doing OK. I had set the bar low, aiming for a 75% but got a 77%. I can live with that! I had 3 weeks of classes for which I barely picked up a book.

When I'm at home, I feel like I should be available to my partner (who is admittedly, quite needy) rather than studying for school. I've been talking to other people in the class who have partners/spouses at home. The common theme seems to be that they really really don't understand how much work there is to do in med school. It's as though they sincerely believe that we're just having fun all the time. When I'm discussing my day, I try to focus on the positive aspects rather than the negative - why would I ruin his day with my crap? That may seem to put a weird spin on things.

Part of the problem is how much I need to censor myself at home.

Talking about neat specialities I can pursue in the future leads him to be 1) depressed that he hasn't got a dream of his own to pursue or 2) point out that I can't do everything. Surprisingly, I do know that I can't do everything but having the idea that I could pursue a speciality keeps me focused and working on whatever subject I'm currently knee deep in.

Nothing gross. Unfortunately the definition of this changes daily. Last night it was extended to include a cleanly broken bone. Seriously. I get no puss or tumour talk, but a broken bone???

Discussing the MD/PhDs in the class is strictly forbidden as they act as a reminder of his unpursued potential. If he really wanted to use his PhD in Biostatistics, I'm sure he could!!

All this censoring makes regular conversation difficult, especially when it comes to the tough topics like money. Argh with the money!! /end rant

I have finally been brave enough to ask for observerships. I don't know how my classmates have been so quick to find them! I felt like I was asking for a favour and that's hard for me to do. It's really exciting to get an opportunity to see what the "real world" of medicine will be like! My first is set up in geriatrics, the next in child psychiatry. I'm 95% sure I'll be a family doc, but I want to check out the specialities too so that I can be confident in that choice and so that I can be the best family doc ever.

How did I become this person?

My first block exam is soon. I'm not remotely ready despite promising myself that wouldn't be me. I'm terrified of failing out of med school.

I'd go to church but I don't like the wine

I keep waiting for someone in a white coat waving a cane to come running into the classroom, pointing at me and yelling that I'm not supposed to be there. So far this hasn't happened. It's only been 5 weeks though, there's plenty of time for that.

Before coming to school I was incredibly torn about what I was going to do for orientation week. Here I am, significantly older than my classmates, not able to hold my liquour (as a lovely going away party proved) but still wanting to make connections with my classmates. These are the people I'll be working beside, not only for the next few years but as my colleagues for the rest of my life. I want to make a good impression. I want to be someone that people will study with. But mostly, I want to be liked. Whoever said that med school is just high school, take two, wasn't exaggerating. The class is quite clearly divided, not just physically into front vs. back, left vs. right but also the partiers, the jocks, the book smart, the religious and me. I don't fit into any of the groups but seem to have been adopted by the religious.

It's weird. It's not that I don't like like religion. Many of the best religions serve wine at service which I can't help but endorse. It's just that it's not me. It's not just Christians in this group, there are Muslims as well. What will they all do to me when they realise I don't go to church? Will they wave a cane and kick me out as well? What will happen when even the religious nerds don't want me?

Due to logistical issues (I was commuting from another city) I didn't hit the major parties in O-week, especially toga. This meant that I missed out on a huge opportunity to meet a large portion of the class. I wanted them to get to know me before making judgements about me based on my age and my non-athletic nature. They will know soon enough that I've only got an average intelligence, that I'm not very quick on my feet and speaking of feet, mine spend most of their time in my mouth. I wanted them to get to know the fun me first.

As long as I can keep my mouth shut for the next few weeks, there's always Hallowe'en.

She was sick too

This post http://kateharding.net/2007/07/12/fat-hatred-kills-part-one/ shook me, and hit too close to home. My mom was never diagnosed with problems with the blood vessels in her legs and almost died because of them. Her doctor always told her that the pain in her legs was due to her weight. I'm proud of Mom. Despite this, she knew something was wrong. Yes, she was fat, but her life didn't have to be so painful. She eventually had an angioplasty done and now works out almost every day. She's still fat, but she's living her life too.

It's easy to judge someone, make a snap decision about what their problem will be. I do it all the time at my job as a reception clerk. When I see someone coming to my desk, I decide before they reach me what their problem/question/quirk will be. 98% of the time I'm right (I'm just that good), but the times I'm wrong, I'm really wrong. It's often humbling.

I hope that I'm able to remember that it's not just that my patient is fat, she's sick too.

I may be a little evil

Yesterday was my final day for getting my shots. All together over the past month I have been stuck 6 times to get titres, do a 2-step TB test and be inoculated against mumps, measles, rubella; tetanus, diphtheria; Hep B. The frequent flier club has its privileges though - as I was waiting for my shots yesterday, the nurse recognized me and rather than going to the computer to see who was next, ushered me in. Yay.

While we were going over the form I filled out to get the shot, I heard little running feet.

Then I heard a scared voice repeating "I don't want a needle, I don't want a needle..." The little girl was clearly hiding in the corner just outside my own room and not at all impressed with what was about to happen. They finally got her scooped up and back into her own room. I could tell because the crying became much more persistent, then after the needle, just sad.

I couldn't stop laughing.

It's not that I did feel for the kid, needles really do suck, but this was one of those character building/"good for you, really" kind of things. Like the child that won't eat vegetables, this one knew she needed the needle but didn't care right then. The unfortunate thing for her is that her family is relocating to India in a few months and she needs to be inoculated before she can leave. She came by my room and the nurse offered to let her watch while I got my needle, just so she would have a better idea of what was happening. We talked to her about what was going on and why and she looked very attentive. I told her this was my 5th shot and she asked me if I'd cried. I said no, but I made a funny face during on of the needles. She got this very serious look on her face and told me that she cried. I said that was OK, it's expected, but it's not so bad now right? She was fine and started telling me about her soccer game that night. Hilarious.

I kept giggling.

The funniest part though, was the reaction of the poor nurse who had to stick the beautiful little girl. She was teary when she finished and needed to go to the break room to pull herself together again.

My nurse told me I thought it was funny because I would pass the hard needles like that one onto my nurses. I sure hope I'm not that afraid of kids!

When I asked my doctor if it was wrong that I thought the drama was so funny, she said "no, there are hilarious things that you'll see every day. The problem will be to fight the laughter."

That's definitely going to be an issue.

I figured that now that I was in, there would be no more hoops to jump through, much less, flaming ones.

Getting to the point that I was accepted was one hoop after another to jump through...get a decent GPA, succeed at the MCAT, get some killer volunteer experience, what??? in a clinical setting?? crap..., make the interviewer like you, now it's getting all my info in on time.

Vaccinations, letters, the name I want on my name tag, oh, my.

I have a place to live - check

I have the letter that says I'm physically able to attend - check

I've been vaccinated against everything under the sun - almost

I've sent in the letter that says it's ok that I wave all responsibility for bodily harm to me - gah!

That one scares me. I'm sure it's just to protect themselves in the case that I get a needle stick, but it's such an intense form. I'm too young to die!! Plus I just got into med school and I don't want to!!

Don't mess with my coffee

Among my list of things to finish this summer before starting meds in the fall is a round of vaccinations, blood tests and titres. This week I had 4 titres read to see if I need the vaccination/booster or not, 1 vaccination, one booster and a TB skin test. Ow.

As I was leaving the office, the nurse told me that I couldn't drink coffee for the rest of the day. What?? That wasn't in the fine print she made me read before signing the papers.

It was her little joke because I had taken so many pin pricks. Ha. Ha.

Flying out of Boston last summer, I was hungover, grumpy and desperately low in caffeine. I picked up a Starbucks latte on my way into the airport and was barely through a couple of sips before I made it into the security line ups. The woman behind the X-ray machine told me I'd have to dump the coffee out, I couldn't bring it with me. I tried to keep myself composed, but clearly she had gotten the reaction she was looking for because she giggled and told me I could keep it. Grrrrrr.

I will not, do not, react well to those who insist on coming between me and my coffee.

Gratitude

I've been attempting to express my gratitude for all the folks who have helped me during my undergrad.

I ran into my first year calculs prof. He was especially helpful for me. I came back to school as a mature student and was sure that everyone would think that I was some sort of freak. On top of that, I didn't remember anything from high school. This prof made me feel like I belonged at university and that I could do well. He showed me how to access the resources on campus and I ended up getting a 92 in the class. He also proved to me that profs can be approachable and for the most part, people will want to give me a hand if I ask. As we were walking I noticed a squirrel on the walk who suddenly went flat and I commented that it was a pancake squirrel. The squirrel then scuttled along the ground towards a tree. I wondered if it was sick. I realised after about 5 more steps that she was ready to be mounted. And I felt incredibly awkward and couldn't wait to get away. Yikes.

There are so many other folks I've been thanking as I go through my summer. All the wonderful folks who helped me prepare for interviews, the pep talks from office mates, study buddies...

I know that I would not have been able to get into meds school if it weren't for all the people along the way to hold me up.


These are the same people I will blame for not stopping me when I'm knee deep in ca-ca.

Yikes.

I'm officially no longer enrolled in the Master's program.

Yikes.

A choice is made

I was accepted by a Masters program that I was incredibly excited to attend and had already accepted their offer (it came well before my meds news). I've been sitting on my meds news for over a month but I have just finally sent my decline of their generous offer. It's been worrying me b/c we're broke. Completely stinking broke. At least the Masters would have paid my tuition plus some.

It was also going to be doing something really interesting to me--studying the choices that obese people make and the reasons why despite knowing better they continue to keep making the same choices. I was going to work with the teaching hospital to perform surveys and analyse the data to make recommendations to the government and schools for teaching kids to be healthier. Pretty exciting right?

It was also something I already knew I would be good at.

Enter my good meds news, and all the self doubt it entails.

Today I started the process of letting the folks offering me a masters know that I'm not coming. My heart is still racing. I really feel like I've just jumped off a cliff.

I giant, scary, exciting cliff!

Insecurities

I've been spending some time trying to look younger. When I go to school in the fall, some of the folks I'll be studying with will be 14 years younger than me. 14 years!!! I went through facebook and removed everything that might tells someone how old I am. I've also been perfecting my "I'm 28" response and using masks and revitalizing night creams. It's pretty ridiculous. I just know how judged I was during my undergrad as a mature student. It took 2 years to make friends, but I only have 2 years in med school to convince these folks that I'm not a creepy old person and I have just as much right to be there as they do. I've been watching the OC and Grey's Anatomy in an attempt to gain some cultural cred/be able to speak in short cuts to my class mates. Do people even watch the Simpson's anymore? I sure hope so, that's where most of my references come from.

I don't want to be lonely in a class full of people who are all tight friends. Is it inevitable?

Money

So now I know, med school is frakking expensive. I thought that some magic fairy would throw some dough at me -- apparently no fairies. This is a scary scary day for me. I have my old student loans that are non trivial plus impending extra debt to be dealt with. I'm freaking out. The niggling thoughts are louder today. What if I can't pay it back? What if my partner freaks out and leaves me with all the debt? What if I flunk out? Where will all the money come from?

I think a beer is in order.

And so it begins...

I've had these nibbly little thoughts lately, ones that are desperately trying to get my attention and that I am desperately trying to ignore. I've been accepted into med school, I'll be starting this fall, but am I doing the right thing? Should I be taking the acceptance into a masters program instead? At least that would pay me to learn.

But most importantly, don't these people know that I'm just faking it? That I don't know if I can be a doctor? That I am an imposter? What if I'm found out? What if someone asks me an incredibly difficult anatomy question on the first day? What if no one likes me?

Chatting with some friends in similar, yet clearly different boats, I realise that I'm not the only imposter. There's a bunch of us hoping to fake it 'til we make it.

http://en.wikipedia.org/wiki/Impostor_Syndrome