To the Mom at the Pool

To the mom at the pool today in the bikini, with the rounded yet sagging stomach and faded stretch marks… I commend you for being far braver than I am in my postpartum body that I refuse to accept so comfortably. 

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A Chance to Breathe

It’s over.

Over, over, over.

Friday was the big day. The day itself went fairly smoothly. I used all of the allotted time, I used my breaks to completely de-stress and start fresh for the next blocks of questions. At the end, though, I had no clue how to feel about the exam as a whole. There were a good amount of questions that were easy (what’s the diagnosis based on this picture) and then there were a good amount that seemed to come out of left field and I had no clue. I took several practice exams in the weeks leading up to the exam, and my ‘scores’ on those tests were around my goal score…. but I felt like those NBME exams were SO MUCH EASIER than the real thing. All I can think now is that I just really, really want to pass, and even if worse comes to worst my score is lower than I hope then I’ll just deal with it and work on crafting my CV and residency application to show off my better strengths… I just never want to have to take Step 1 again.

I don’t mind having to take a comprehensive exam after finishing half of my medical school education. What I haven’t liked, however, is the undo stress that has been building up all year on me and my classmates and friends. Even though there are other Step exams before we can become licensed, this one carries the most weight and is what everyone stresses out so much over. When you take a bunch of Type A perfectionists, make everything a competition, pair it with insane educational debt, and then hinge our future careers on a single 8-hour exam… it’s a pressure-cooker. It is unpleasant.

Thank God it is over.

People were talking afterward about crying in their cars. I don’t know if it was metaphorically, because it was such a difficult exam, or if it was a stress-release mechanism. But once it was over, I didn’t cry. I didn’t feel like I had been hit by a bus (but I probably looked like it). All I could say on the way home was, “…. I hope I passed. ….”

Studying for Step 1 has been controlled by Murphy and his Law, if you know what I mean. Everything that could have happened did happen. On Monday, as I’m starting to get panicked about my upcoming exam and I am reviewing the highest-yield topics just one more time to have it solidly memorized, I get a call from daycare at 8:30am… the Ladybug was breaking out into a rash over her entire body. Which meant she couldn’t stay at daycare until it went away–meaning that I had to find a babysitter for the last few days before my exam, or submit myself to not studying for the entire four days before Boards. I was panicked, but it all worked out. David took off work, my mom took off a day of work, my mother-in-law came to visit, and my brother babysat the day of my exam. This was the second time Ladybug got sick in the 7 weeks I took to study for the exam. I took a bit longer than was recommended (most people say 5-6 weeks maximum), but I knew I would lose a few days here and there for unforeseen reasons. I was also sick with a bad case of sinusitis. And then there was the accident right around the time school let out. So it was actually rather funny to call my weeks of study time “dedicated” study time.

But, it’s over. I found out if I passed/what my score is sometime next month. Murphy and his Law couldn’t stop June 5th from coming (and I refused to change my test date), and now that day has come and gone and I get a few days of “summer vacation” until I have to report for third year orientation.

Did you see that? Third year orientation. Is this real life? How is it that I am now ready to be set loose on the wards?

In speaking of which… I got my first rotation schedule the week before the exam. I can’t remember if I wrote that in the last post or not, but it’s true–I have a tentative schedule for my first rotation of third year. My first rotation is Internal Medicine, which is split into a month of wards and a month of two specialties. I start out with the specialties–two weeks of Cardiology at the VA and two weeks of Infectious Disease at the VA. Then a month of ward work at University. I am so excited! Real patients to learn from, and real H&Ps and SOAP notes to write. As much as I always wanted to study the medical textbooks before I came to medical school, the real reason I came to medical school was to be trained to take care of real patients. It’s about time!

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One Week to Go!

I take Step 1 in one week. In all honesty, I will be so thankful to have it over with. Seven weeks in study isolation with my falling-apart copy of First Aid (minus my time spent on DIT videos… that’s social interaction, right?) have nearly driven me mad. Especially when we have had some gorgeous weather (so I’ve been told…) and I haven’t left my study area in that timeframe. When I do get a quick chance to run to the store, I feel like I don’t know how to interact with society….

I did take one day to get all of my paperwork done for the VA (I was hoping that my old VA paperwork would transfer from Indianapolis to Louisville, but I was out of luck there and had to redo all of it), even though I didn’t know if I would even be spending any time there on rotations, not having our schedules yet…. which turned out to be a good thing, because this week I got a very short list of my schedule for my first rotation! I will be starting my Internal Medicine rotation at the VA, two weeks on Cardiology and two weeks Infectious Disease! Those were my top choices for the elective month of my Internal Medicine rotation, so I’m pretty excited. The second month of my IM rotation is at University Hospital where I’ll be on wards (I’m not even 100% sure what that means). My first rotation starts one month from today! I’m really hoping for great experiences on this first rotation as a third year medical student, as I figure out how medicine works in a real setting, all day every day. How is it possible that my first two years went by so quickly?!

So that is a quick update from me. One week til Step 1, one week and two days until we celebrate a special girl’s first birthday, and less than 3 weeks until we take our longest family vacation ever. I cannot even tell you how excited I am that this is almost over and I get to spend some time with my family in the mountains again.

Back to studying. #CrunchTime #FinalPush #JustKeepSwimming

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Step 1 Studying and Looking Forward to Rotations

I am now well into studying for Step 1, the first exam of the medical licensing process in the US, and here are several thoughts I have about it:

1) It’s a crime that I have to be studying inside all day when the weather is this gorgeous and summer-y.

2) I am amazed by the amount of information that I have remembered…. and by the amount that I have forgotten. =/

3) I am actually enjoying what I’m studying, since I’m going at my own pace. Medicine is so interesting to the scientist I am at heart, but we don’t really have time to enjoy it while we’re in classes. We’re always rushed into the next thing, expected to have learned all of the nuances of the subject instantaneously.

4) I cannot wait for this exam to be over so I can move on with my life…. and more importantly, enjoy our girl’s first birthday and a short vacation to the mountains and away from the books.

5) After this, they’re actually going to let me loose in the hospitals?!?!

6) I am so excited for the clinical years of my education that I can barely stand it. I start out in Internal Medicine in early July.

While studying has taken up most of my life in recent weeks, we have had some fun. My brother graduated from college last weekend (which makes me feel really, really old), and we got to be in attendance. Today is his party. On occasion I get to take a break to eat dinner with friends, family, and of course, David. Ladybug chose the weeks during my dedicated study time to learn to say “hi!”, “dada”, and “uh-oh!”, get a third (and almost a fourth) tooth, finally decided she wanted to use her sippy cup (as demonstrated by stealing everyone else’s at daycare), finally decided she wanted to have snacks that she refused at home (as demonstrated by…. stealing everyone else’s at daycare….)…. and she is oh-so-close to walking by herself. She’s 11 months old today and I have no idea where the time went.

Now that the little one is down for a nap, I think I will take a shower and start today’s studying. Happy weekend! =)

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That’s a Wrap!

Kentucky Derby Festival Half Marathon finisher's medal 2015

Kentucky Derby Festival Half Marathon finisher’s medal 2015

Second year is over. Done. D-O-N-E, done!

And now the real fun starts: Step 1 dedicated study time. I am thrilled (kinda-sorta not kidding). Studying is going well so far. I’m nearly two weeks in and not totally miserable yet, although I am losing some motivation. Today it has been especially difficult to sit down and focus on the task at hand. I did take the entire weekend after the Pathology shelf (our last exam of second year) off as my “summer” break to spend with the kiddo and the hubby before I locked myself in my Step 1 dungeon. In that short time frame, we saw family and friends, played with the kiddo, and planned the kiddo’s first birthday party.

In speaking of said kiddo, since I started Step 1 studying, she has decided that she wants to try to walk, waves and says “hi”, tries to say “dada”, decided she will try her sippy cup all by herself, and she now likes the snacks I’ve been trying to get her to try now that she got her third tooth in. I don’t know why she decided that my dedicated study time was the time she was going to use to grow up too quickly, but that’s just how it is.

The end of the academic year was madness. Sheer madness. Between a sick kiddo on multiple occasions, and getting into a vehicular accident, things didn’t exactly go as planned. I only got in one full day of studying for the Pathology shelf, but I managed to go through the entirety of Pathoma so I still felt pretty good about the shelf.

Once all of that settled down, the only other “fun” thing I’ve done since school’s been out is to run my second mini (or half) marathon… 13.1 miles for the Kentucky Derby Festival Marathon and Half Marathon. David, God bless him, ran it with me so I didn’t have to do it all by myself. I wouldn’t have finished it this time if it weren’t for him; I didn’t get to train for it as much as I had hoped (never enough hours in the day), and so it was a long and slow process…. the rainy day was demoralizing as well, but we finished, and my medal is going to my Medals4Mettle kiddo. At ULSOM, our Medals4Mettle chapter pairs us with a kiddo in the Heme/Onc division and we can give them our medals. It is a great program and I am really glad I decided to do it this year. This was a painful race that has me trying to decide between never running again… or doing a lot more, and more frequently. Today’s verdict is: sign up for more. BUT only if I can train for them better than I trained for this one….

So, that’s it for my short study break. I’ve been pretty good about sticking to my study schedule, so I’d like to continue that streak and finish today’s sections before the kiddo comes home from daycare. See y’all in June!

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Spring Break

After much anticipation, my last real “break” before the beast Step 1 takes over my life has arrived.

The past few weeks have been pretty intense. We had our Block 6 exam, which covered four classes instead of three, and we had less time to study for it–it was held on a Wednesday instead of a Friday. This gave us some extra time to study for the microbiology shelf exam that is “must pass” this year, and counts towards the requirement of 70% average on exams for this year. To pass the shelf, we had to achieve a score higher than the bottom 4%… doesn’t sound too bad, right? It still works out to be around a 70%, so we couldn’t exactly totally ignore it.

To add to my already busy schedule, we had to make up LSP clinic time from the snow days. While it wasn’t a big deal, it just added to my jam-packed schedule. We are so very close to being done!

Over the weekend, David and I had an actual date night with just the two of us (not that I don’t enjoy date nights with all three of us, but it was a nice change–and Ladybug’s aunt and uncle enjoyed the playtime), I finished one of my projects, had lots of family time, took Ladybug to her 9mo checkup, and today I have a massage scheduled to work out the stress I’ve built up. It’s been a great “break” so far! The weather has been amazing too, which just makes my soul happy (or is that the Vitamin D?). This weekend, we take off for Memphis, TN on a mini-vacation that includes taking the ‘bug to the zoo for the first time (weather permitting), and I am so excited.

So this is it: Block 7. Endocrine, female pathology, psych. One ICM exam, the block exam, and the path shelf. That is all that is left of my second year of medical school. I have greatly enjoyed this year, sans pregnancy brain, but I am really looking forward to third year and being on the wards, finally!

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Columnist

Now that it finally went live, I can share with you the very first article of my new column on in-Training, Cheerios and Stethoscopes. (See, I wasn’t lying!) It was a hard piece to write due to its (obviously) personal nature, but I really wish I could have found something similar to it to ease my worries before I was pregnant.  

http://in-training.org/pregnant-first-year-medical-school-8380

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Elective Time in the NICU

For second year, we have to do 2 credit hours’ worth of elective time. The trip to Ecuador could have counted as my elective time, but since I didn’t get to go (which turned out to be a blessing, since the Ladybug made her entrance during the trip’s two-week timeframe), and since I didn’t want to take time away from my family during the school year by volunteering at the student-run clinics, I had to find something else that would count toward this requirement. One of our options was to do Career Exploration. We could do 24 hours with one physician for 2 credits, or split the time between two fields, 12 hours each. That choice was pretty simple; since I didn’t get to do my Pediatrics Externship in the NICU, I asked my Advisory Dean, Dr. T, if I could do my hours with her. I love getting to go into the NICU with Dr. T. We’ve had a ton of patients, I’ve answered lots of “pimping” questions (and learned this: being “pimped” means being Put In My Place… didn’t know that’s what it actually stood for!), and I’ve learned a lot not only about medicine, but about how to select a residency, things to consider for fellowships and employment… lots of stuff. I’ve listened to lots of murmurs, seen some really fascinating computer-generated models of heart conditions, and learned about rare genetic conditions.I tend to take awhile when I listen for murmurs, in attempts to hone my (limited) skills, and I’m always glad that Dr. T lets me take my time.

One morning, we even got to travel to another hospital on a consult for possible Down Syndrome/Duchenne Muscular Dystrophy. Another morning, we were doing well-baby exams in the regular newborn nursery (in the same hospital where I had Ladybug) when we got a page to L&D for a premature (36 weeks) delivery. This was the first time I’d been in L&D since I was a patient nearly a year ago. Dr. T had me gown up, and as I slip on my gloves, she turns to me and says, “When they bring him over, clean him off, suction him, figure out his apgar’s, and help with length and weight.”

“Ok.” No need to tell me twice.

And it was amazing. A big, healthy boy with wrinkling skin indicative of a gestation longer than 36 weeks. The dad was brimming with pride as we examined his boy.

On the next shadowing day, we got another page to L&D, this time to the OR. Twins! Incredible. OB is on my shortlist of career options, second to pediatrics, but I’ve gotta say, I was glad to be with the team that went with the babies.

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My First Diagnosis

…and it’s not what you think.

The memory of that day has haunted me ever since.

My grandma called on a Sunday afternoon, which used to be fairly normal. I talked to her for a few minutes, then handed the phone off to dad, since that was who grandma wanted to talk to on Sundays when she called. (I was still in high school, so yes, I lived at home.)

Once dad took the phone, I turned to mom. “Grandma has Alzheimer’s,” I said.

Mom looked at me, startled. “What did you just say?”

I told her about the conversation. In the few minutes I had been on the phone, Grandma had asked me several questions and each one she repeated multiple times, even after repeating my answer back to me.

My Grandpa had Parkinson’s, and later developed Alzheimer’s. Grandma was a retired RN, and took care of him in the home they lived in for ~50 years. He never spent a single day in a nursing home or hospital. I was quite familiar with what these issues looked like. During those few minutes on the phone with my Grandma, I knew. My blood ran cold and my stomach churned. A few years later, an actual doctor diagnosed her with Alzheimer’s (presumptively of course, since plaques and tangles can’t be confirmed until autopsy, if one is performed). We lost her tragically on Thanksgiving during my first year of grad school.

This week we’ve started our final new course, Clinical Neuroscience, and we started the week with neuropathology. Learning more about cognitive disorders has kinda freaked me out this week, and awoken some memories I guess I had repressed. I think what scares me most is wondering. I have no idea if maybe I carry the ApoE4 gene… And I do not want to know.

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Registering for Step 1

Over summer, while I was on bedrest to prevent preeclampsia, I spent some time researching how to register for Step 1 and how to build a study scheudule (mostly because I was so bored while on bedrest and had the free time). From what I found, it looked like I didn’t need to worry about that until at least November, which seemed forever away at the time.

Right before the Block 2 exam, my class got an email about how to register for the exam. Being so close to block week, I put that on the backburner. It wasn’t until a week and a half before Block 3 that I finally went through and looked at the email we got from school about how to register for it.

I was officially registered for my test date by early November. Most people don’t register so early for the exam, and it’s really not necessary to do so, but I had my reasons for wanting it done and out of the way.

Over that previous summer, we were told the date we needed to take the exam by (June 23rd or 24th) so that we have it done before third year orientation. My daughter’s birthday is in mid-June, and we wanted to have a few weeks between my Step 1 date and orientation for a family vacation. Knowing this, and knowing how many weeks I wanted to take for dedicated study time, and factoring in days off for special events (my brother’s college graduation ceremony, running my second half marathon, etc), I knew the target date that I wanted to take the exam. I also knew which testing site I wanted (the one where I took the MCAT, a very small testing center close to home). Since the testing site was really small, and since I still had plenty of funds from my loan disbursement (this test is more than $500 to take), and knowing that I HAD to have that exam over with before my daughter’s birthday, I knew I wanted to register as soon as possible.

It was actually a really easy process. I went to the NBME website, logged in, and selected my three month window of when I wanted to take the exam. I then could print off the form I needed school to sign saying that I was eligible to take the test (gotta love security measures, right?). Luckily, I still had extra copies of my last passport photo, so I could use that for the form (again, gotta love security). Then I had our academic affairs staff sign the form and add the school seal (security…). I then had the letter sent overnight mail that required a signature so I could track it, and so that I knew without a doubt that my sensitive information was received (it was only a couple of bucks, so I didn’t really care about the extra cost). When the NBME received my paperwork, I got an email saying that it would probably take 3 weeks to get my official testing permit sent to me; I needed the testing permit before I could log back in to the website and look for a testing center and select a date (the security on this exam is nuts!).

It didn’t take three weeks. I had my testing permit in less than three days. I immediately logged into the NBME site, chose my testing center, and they still had plenty of seats open on my target test date. It was so easy, and so quick to get it done by registering so early. Everyone’s situation is different, but doing things this way made it a lot less stressful, and I didn’t have to think about the registration process anymore. If there’s any advice I could give about registering for the exam, it would be to register early to get it out of the way.

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