Today is atypical; let me give you an example of typical

Today I am sick. This means that I'm doing school work at home, in my jammies. Some of my classmates do this every day. I like going to school, though, because classes can be helpful. Something about actually seeing the professors is good. Needless to say, though, that today is atypical. I slept until 10 and am already considering a nap. My head is full of cobwebs and my brain is trying to exit through my nose. Gross, I know.

But what is a typical day for me?
4:30am - cat starts batting at my face; he thinks it's food time. I ignore him.
5:00am - alarm goes off. I hit the snooze and lie there for five more minutes. Then, I get up and gather everything together. Books, clothes, food.
5:45am - feed the cats and leave for the gym.
6:00am - arrive at gym. Somehow convince myself that it is a good idea that I do this most mornings. Claim an elliptical/treadmill.
7:10am - realize that it's 7:10am and run to the locker room. Shower.
7:45am - go to car, swap gym bag for school bag and breakfast.
8:00am - arrive in class, eat breakfast, and sit in same seat for four hours.
12:00pm - lunchtime! sometimes I actually get to eat with friends. Other times, there are meetings.
1:00pm - 5:00pm - class.
5:00pm - on most days, I am able to head home and study until husband gets off work at 6pm.
6:00pm - husband gets off work, cats demand food, we make dinner and feed cats. We talk about our days and eat together. Sometimes we watch something funny.
7:30pm - study for a bit, or until bedtime.
9:30-10:00pm - we head to bed and/or play card games for a bit and/or read.
11:00pm - we actually fall asleep.

I've been called a gunner a few times this week. "Gunner" for those not in the know, is a word used in medical schools to describe very driven students, often in a negative light. In my mind, at least, "gunner" connotes a negative sentiment.

I also feel like I'm the least gunner like person I know. Yeah, I'm trying to do my best in medical school, but I would never sabotage my classmates. I also pretty much don't care how I do in my classes anymore, so long as I pass the courses. I've also started casually studying for boards, which is apparently quite weird. I think it makes sense to study as we go through the courses; I've purchased a few books and I'm working through them along with my courses. We'll see what happens with this.

I just don't feel like a gunner. My classmates probably meant this in more of a complimentary way than I'm thinking...at least I hope so...

Nature

Today, one of my professors, who also happens to be a physician (shocker, I know) gave me an assignment. She told me to go take a walk outside for at least 20 minutes.

Best homework ever.

Halloween

A little boy came to our door dressed up as a compact fluorescent light bulb, complete with a band that listed his wattage and amps used. Best costume ever.

October

It's currently my favorite time of year. It's the time of year that (at least in New England) wild turkeys run rampant and wild along the highways, that frost lingers in the air, and that everything is pumpkin flavored. I love fall, and it is 100% more awesome here than it was in Washington State. People here get really into fall. They go on hay rides, make really elaborate corn mazes and open them up to the public, float pumpkin boats down rivers, and attempt to make anything and everything pumpkin flavored. It is a pretty awesome season.

Yesterday, my husband and I went to the most massive corn maze ever with another couple. The theme was "Under the Sea," and supposedly if you looked at the maze from a helicopter, it actually formed the image of a lobster and other sea life. It also encompassed 5 acres of maze goodness. There's something really neat about running around in corn fields. After we finished the maze, we went on a hay ride to look for pumpkins. That was fun too, although we left without pumpkins. You have to find just the right one, y'know? It has to speak to you. This same farm also had a corn cannon, where you could shoot ears of corn across a field to hit wooden cut outs. Although we didn't try it, we got a big kick out of watching little kids attempt to hit a blue cow made out of old oil drums.

Anyway, I'm on day four of a four day weekend, which means (predictably) that I've had a lot of fun and gotten plenty of sleep but I haven't accomplished much in the way of school work. That's today. It's time to learn about psychiatry.

Neuro drawing to a close

Our last neuro exam is on Friday. It will emphasize diseases, radiology, and pharmacology. This is great, because most of us totally forgot about the pharmacology part due to being overwhelmed by the neurology part. As such, due to our fear of failing neuro, we're all going to fail pharm. We clearly planned this well.

I wrote a haiku.
"Primary brain lymphoma / ring enhancing pics / periventricular spread."
Clearly, I've lost my mind. But I remember things about primary brain lymphoma now...

You know you live in a small town when...

Your bank calls you to wish you a happy birthday, and it's not an automated call.
Dogs sleep in the middle of the road and cars drive around them (this happens when I drive to school periodically).

In other news, neuro is grinding to a finish; our last exam is on October 2nd. I think it's safe to say that we're all pretty much ready for it to be over, although there are certainly a few budding neurologists in our crew who have emerged triumphant and glorious over the material. I, however, am not likely one of those people.

Tomorrow I have the second of three tests for our Neuroscience class. This one is purported to be the most difficult; as such, my classmates and I are finding ourselves both panicking about the amount of material and lacking in motivation to study the material. Case in point - I'm writing this right now.

So I posted a note on facebook, asking people what was one memory they had of me. My brother (who I didn't grow up with past the age of about 2) replied, saying that I "wore a tiny little football helmet and didn't make eye contact."

I think it's interesting what his 7 year old self noticed about me before I vanished from his life.

When I grow up...

Here are (in no particular order) the things that I am thinking of being when I grow up.

*General pediatrician - I like kids. They are fun to care for.
*Pediatric palliative care doctor - I like kids, families, comfort care, and counseling. Also, I have an "in" at one of the fellowship sites.
*Palliative care doc - this is the non-pediatric form. I like it for pretty much the same reasons as the pediatric form.
*Physical medicine and rehab - helping people regain function is awesome.
*Child psychiatry - this is actually the thing that set me on this long, circuitous path in the first place; I took general psych when I was 16 years old, loved it, wanted to do more and go to medical school, and very shortly thereafter convinced myself that I wasn't smart enough to do so. Then, five years later, I took a neuroscience course that made me realize that although I might not be smart enough, I am determined enough.
*Neurology - I like brains. They're fun. I like puzzles. They're fun.

Basically, I like the notion of comfort in medicine. This is what I get from this. With the exception of just being a general pediatrician, all of these options would require either a 3 year residency and a fellowship (usually 1-2 years) or a 4 year residency (PM&R, combined peds-psych, combined peds-internal meds) or both.

Yikes.

I haven't written in a while; there are a number of reasons for this. The most compelling is that I am in the midst of learning everything humanly possible about neuroanatomy and neurology in six weeks. Additionally, I'm lazy. Also, there are some strange things occurring around me. Suffice it to say that medical school is keeping on keeping on, and there is minimal drama (ok, so the lack of drama is a lie).

Another year, another $60,000

Second year is started; we're going full swing at this point. If you live in New England, you'll know that summer just now started. This past week, it's been high 80's-mid 90's with 75% humidity. It's great times, studying instead of being out on the beach.

Also, if you live in New England, you know that the mosquitoes are pure, unfettered evil. You go outside and get bit immediately.

Med school is expensive. I'm weighing financing options that include but are not limited to joining the army, national health service corps loan repayment plans, public health service corps, just paying off the quarter million, working in under served areas or public service for ten years while making income based payments and then having the remaining debt forgiven, and getting a wealthy benefactor. As of this point, the two top options are joining the army and doing the ten year public service/loan forgiveness program. I'm honestly torn between the two, because they both honestly have some benefits and negative points. I've been talking to loads of people about both options. There are quite a few military scholars at my school, all of whom have had different experiences. We'll see what's in store, I suppose.

One of the things that some folks struggle with while in medical school, or grad school, or any kind of school, really, is putting off starting a family. I know that I want kids, but I also know that while I could have them in medical school and/or residency, I wouldn't be able to be the kind of parent I want to be if I do that. Thus we wait. It's hard, though. I love children and both enjoy and hate watching my friends have children. I am so pleased for them; so far, they have all proven to be good parents. I get great joy out of seeing their children, playing with them. I know logically that we will be able to be better parents in a few years, but that hasn't stopped some of my peers from having children and being good parents. A gal entering third year is expecting and is thrilled. An acquaintance of mine is going into fourth year and his wife is pregnant. Not perfect, perhaps, but not the end of the world either.

Partially, I am afraid that when it is time for me to try to have a baby that I won't be able to. I didn't really make plans for my life, but part of me always thought I'd have kids by the time I was 30. At this point, that might not be entirely likely. When the time comes, though, will I be able to have a baby, or will I struggle to conceive? Will we be eligible for adoption? My parents were nearly too old when they adopted me; apparently Oregon had strict adoption laws in the eighties. Now they simply can't afford road signs. Oregon is a weird state. What if I am "too old" to have a baby?

Maybe I'm just frustrated because while I am doing this school thing, my friends are doing other things and leaving me behind. At the same time, I really enjoy my schooling. Gah.

The most ridiculous thing ever

I've done a lot of nutty things this summer. There was the time that I walked into the Charleston Naval Shipyard and asked if it was Massachusetts General Hospital. That was funny, wasn't it? Then there's the whole hanging out with people while they die thing. This is less funny, but it's not something that most people do during the summer time. I also convinced my husband (not to mention myself) to scale a rock face at Acadia National Park. This particular hike is called "The Beehive" and although it's purportedly only 0.8 miles long, it's pretty ridiculous.



Today, though, I think I may have outdone myself.

Every Thursday for the past month or so, I've been attending the didactic sessions that the palliative care fellows go to, sort of to get an idea of what it's like to be a palliative medicine fellow. They're fun and I understand about 5-10% of everything that is said. All in all, they're an excellent use of a Thursday morning. Today is the last one that I'll be able to attend, and I'm stuck in Wakefield. This is because I've lost my keys somewhere in this house, and I CAN'T FIND THEM. It's beyond the point of even looking at this point, because I've already missed my bus by about a half an hour, and even if I could find them, I couldn't get all the way from Wakefield to Dana Farber by eight o'clock. It's just not feasible. Even if I could, I can't leave the house because, well, this isn't MAINE or Lummi Island, where you can leave your house unlocked and your keys in your car with the windows rolled down and not worry about anything. Wakefield is a nice area, to be sure, but it's not that nice. And I'm not leaving my friend's house completely unlocked.

Oh well. One of the things they were gonna talk about today is delirium, and there were like four MSTAR presentations on that on Tuesday.

The pictures were taken by one of my classmates as he hiked the Beehive at Acadia.

I brushed the cats and got enough fur off of them to build another cat.

I am also officially overweight. I didn't go to the doctor, but pretty much every good source that I can find on the internet says that I'm at least ten pounds overweight. This is a huge deal for me, because although ten pounds isn't that much, it's the notion that I'm overweight at all that gets to me. I try to exercise and am fairly successful; I generally exercise between three and five days a week, for about an hour at a time. I feel like I eat ok, but that is clearly not the case. I think the main issue is that while I eat healthy overall, I eat too much of those healthy foods. I think it's the portion size that is the problem. I mean, I don't live on donuts, cupcakes, or macaroni and cheese. Sometimes that sounds awesome though.

I think I'm going to start up the No-S Diet again. It's a good diet and isn't really a diet.

Harry Potter today! But for now, back to work.

AFAR MSTAR - the end is near

I (probably) have my presentation mostly done. I'm going to start practicing it either tomorrow evening or Wednesday. It's not exactly the worst presentation in the world; I basically have to talk in an organized fashion for ten minutes, and then allow five minutes for questions from the peanut gallery. I have a few good case studies that I can share, as well as a framework for end of life communication that I can present.

The other slightly more stressful aspect of this is that I'm attempting to write a review of the literature that is appropriate for publishing. The problem that I'm running into isn't the literature search; if there's an article out there about family meetings in the ICU or in end-of-life care or in pediatric palliative care or in palliative care or whatever, I've read it (that is if it was written after about 1990). I've even been fairly successful in keeping track of my search criteria, search terms, and how I culled down the articles. I'm at this point now where I have my big stack of paper print outs and I don't know what to write about. I think I actually have enough for two reviews, one which would present the current view points and frameworks for family meetings in end of life care and one that would deals with prognostication in family meetings. A lot of the articles could even be used to make a third review about family satisfaction with end of life care and family meetings. I just don't know how to write this. They haven't taught us this in our didactic sessions because most people are doing more data analysis stuff. Basically, my thoughts are scattered.

Computers, not casinos. I like it.