Fourth Year Updates

I’m a fourth year medical student now. Wow. Well, my fellow third years who are reading this — there is truly a light at the end of the tunnel. Now, I am actually maxing out my anxiety quotient because I’m preparing my application, but otherwise, fourth year is just nice. Why? You finally get to do things that you enjoy, and all of your clerkships understand and support this. For example, I am on neuroradiology right now, and the residents go out of their way to pull up images that are relevant to what I will be studying. That’s awesome.

I’ve finished my sub-internship for the specialty I will be choosing. It was stressful but I learned so much. It still surprises me when I am actually able to answer questions for third year students rotating through. I was in that spot only a few months ago! I’m also geared up for some away rotations I’ll be participating in in the upcoming months. I’m excited because I am forever restless, and I look forward to just living somewhere else for a while.

Things I’ve been enjoying lately as a fourth year:

1. Reading — I have time to read for fun! This always makes me happy. I’ve been inhaling books as fast as I can, both on audio and on my kindle. Check out my goodreads to see what I’ve been up to and feel free to friend me! I love finding new reading friends. I was on a classics kick for a while. Now I’m just trying to make a dent in my “to-read” list… starting with American Gods by Neil Gaiman, which has been on my to read list for more than 5 years… sadly. But hey, I’m making progress!

2. Podcasts! — I’m truly embracing my auditory learning style more. It was something I struggled with throughout medical school, especially the first two years, because everything here caters so much to those visual learners. I can do visual but I’m much better with auditory (maybe that’s why I picked the specialty I’m going into… ;) ). I also am weird in that I enjoy listening to certain voices. So I’ve been listening to a ton of podcasts. Some of my favorites at the moment: Happier with Gretchin Rubin (easy to implement tips to make your life less stressful), Invisibilia (really interesting insights into human behavior; I can’t wait for it to come back!), All the Books! (best of the new releases). I might actually make a whole post about my current favorite podcasts.

3. Healthier? — Okay. If you’ve been following, you know that I have an autoimmune disease. Well, it’s been eight years, and my doctor has finally pulled me off of my last medication (mycophenolate) as of a few weeks ago. What. Now, this isn’t permanent because I have to give him some blood to see how I do, but still. I seriously don’t think I ever thought I’d get this point!

Another thing thing is I’ve been trying to be… well, healthier. I’m cooking now (this is also to try to save money…). I’m going to the pool to read/listen to podcasts (note: I am so paranoid about skin cancer so DON’T WORRY, I wear too much sunblock, but I am finally in “normal” vitamin D levels). I’m actually running every now and then. All these things? Happiness.

4. Cleaning and organizing — This is my #medstudent personality coming out. I’m in the process of overhauling and cleaning my apartment. One of my roommates just moved out, and before the new girl comes in, I’m trying to clean my space. There’s just something so therapeutic about sweeping, doing laundry, vacuuming, etc. It’s a slow process, but I’m enjoying the progress. I’ve also been cleaning out my closet, and every little thing I have sold on eBay makes me so excited. Yay for making a very tiny dent in my loans!

Lazy patient

I think it’s interesting how when it comes to being lazy*, I choose to take my antidepressant over my immunosuppressant. I’ve been taking my immunosuppressant forever so you’d think that that one of all things would be the one I’d associate most with habit. And, you know, there’s also the part about how it’s the only thing keeping my kidneys from dying. But unless I’m on dialysis in the hospital, I can’t really see or feel my kidneys failing. At least not until it’s too late anyway. And I’m a tangible person; it’s a huge reason why I love surgery, because I like to experience my results. And when I don’t take my antidepressant, well, damn, I know. I know because suddenly things that should not bother me bother me again. I know because I’m self-conscious perhaps to a fault. I want to tear myself down because I’m never good enough. And I might brew on that for a while until I realize that I have indeed been lazy and I should really get back on yet antidepressant.

I’m probably one of the few “surgeon” types who’s so supportive of psych medications. I know most people shrug mental illnesses off as not real or something that is just a weakness we have to deal with. But I’ve felt the effects, and the fact that they feel as real — even more real — than something as physiologic as kidney disease should speak for itself.

*I know… This shouldn’t even be something that one can consider “lazy”. But I’m not perfect, I’m just as much a patient as the next, and yeah, I try but I’m not the most compliant. It was so much easier when I felt every little symptom. But now at I’ve been in remission for almost eight years…. Okay, You know what? I still don’t have any excuses. I should try to remember this whenever I’m on the other side of have bed.

2013 Resolutions and the first steps!

The year I got into medical school (2011), something happened. I’ve been grappling with this issue ever since someone asked me once, what do you want AFTER medical school? And I didn’t have a good answer. After I got sick, even the thought of going to medical school seemed so far away and unlikely that that’s as far as I aspired, and I didn’t think about what I wanted after that. When I got my acceptance, the truth loomed over me — what next? What do I want now? It may also have just happened to coincide with the first year I’ve ever been independent, but when I was sitting down to make my 2012 resolutions, I was at a loss. What else did I really need?

So one of my resolutions ended up being the 20 books challenge, which I did complete, along with a few other resolutions that worked for me. I focused more on building myself as a person and culturing my hobbies.

This year was even harder to make resolutions, especially since I did so well with last year’s. But I finally scrounged around and made nine. I’ve actually finished 1/20 books for this year already, which I’m proud of. Here’s the one I will be talking about today as it’s a huge step for me! 3) Gain weight (5-10lbs) / start exercising. Seriously. (yes, I actually wrote it like that)

After the hospital experience, I lost so much weight. I don’t think I ever fully regained my muscle mass because I just haven’t been as diligent about working out compared to before (for example, when I used to swim). I mostly regained leg muscle because, really, it’s not like I can just not walk around or go up/down stairs. But working on my arms has been a lot harder, probably because I am lazy but also because it’s really hard to face just how weak I became. I don’t know where the 5-10lbs that I’m missing (compared to my base weight) went but I’m guessing it’s somewhere there. It’s been an uphill battle for me to regain my weight, but this year, I’m determined. I’m finally off of most of my medications, and this is the time.

Today I went to the school gym with my best girl friend here at school C. We were careful to eat lunch first upon her advice and one of my other “body builder type” friends’ advice. The gym was calming but filled with confusing machines. I’m so glad I had someone with me. She asked me what muscle groups I wanted to focus on, and I said arms and back. Arms because of what I said above, and back because I’m scared I’ll get osteoporosis. We started with back. OMG! First, I didn’t even know back muscles could ache or be tight. I guess I was just used to sitting and orienting my body in one way. I think the longest/hardest part was when we were trying to fix my form for something, and I learned how uncomfortable it was to arch my back after hours of sitting straight.

The arm weights were the worst. I truly learned how much I had lost. I think the strangest sensation was feeling the crackling down in my forearms every time I tried lifting something.

We finished off with a bit of cardio. I think in the future, I want to go swimming, although I heard rumors that the pool isn’t heated, which doesn’t sound pleasant given the current weather conditions. I also noticed the rowing machines, which I miss from my random crew conditioning days. Right now, I feel sore and light at the same time. I’m also still hungry even though I ate a whole meal after. If I’m to follow my diet, I’m supposed to eat whatever I want whenever, so I think I’m going to go grab some cookies and peanut butter. I weighed myself on the machine at the gym to gauge my baseline. Good luck to myself for this coming year!

Five Years Ago

About five years ago on Thanksgiving, I had one of the worst fevers in my life. Temperature-wise, it wasn’t that high. In fact, I’m positive I felt worse when about two years later, I got swine flu. But I remember shivering no matter how many layers I covered myself in, crying because everything hurt so much, and not being able to breathe.

Three days later, I wrote in my journal: “Last night, I couldn’t sleep because I kept thinking about what it would be like if I literally died tomorrow.” Noteworthy because in my clinical development class a few weeks back, we discussed this weird phenomenon in which people seem to be strangely aware of their bodies and futures in a way that is completely medically unpredictable. Like when someone’s experiencing the worst pain in her life and feels a sense of doom, she’s probably having a heart attack.

Two days later (I was off by one day), I was hospitalized.

But now this year in 2012 a day before Thanksgiving, my doctor told me it was time to finally start taking me off all of my medications. Yes, all. I had been taken off most of them before and prednisone at one point (before getting put back on it) but CellCept too? Yep.

You’d think that for something as big as kidney failure and hospitalization and missing out on school, you’d remember it forever. I do, somewhat, but it’s so easy these days to not think about it anymore. I don’t really have dietary restrictions, I can pretty much do what most people do, and I’m studying to be a doctor myself now, prancing around the hospital in my white coat as if I were completely healthy and not a patient. It’s so easy to forget, especially since almost none of my peers for the past few years ever saw me sick. But about two weeks ago, it just hit me again out of nowhere. And I felt so bad for my poor little sick self. She didn’t know at the time that she was going to get better, get to graduate, get to go to college, get into medical school. Whenever I do remember, I also recognize why I don’t think I’m ready (and may never be) to be a pediatrician or go into nephrology/rheumatology. So I guess what I’ve learned is that time heals some wounds, but you could always be left with scars. And scars, well, they certainly take quite the time to heal.

My current state of health

I have an interesting health quandary right now:

I’ve been sick with some kind of viral infection for a while that causes this horrendously painful and hacking cough.
–> can’t get better because I have a sad immune system
—–> I have a sad immune system because otherwise, my kidneys will fail again
Therefore, I must just wait.

I’m waiting and not recovering. My cough is getting worse sometimes, better sometimes, but doesn’t seem to be doing anything… except today, it appears to have hurt my lungs/ribs/pleura/whatever.
–> it hurts to cough
—–> but I can’t stop coughing because I’m still sick, and there’s nothing I can do about it (see first paradox)
Therefore, I must fight between wanting to cough and dying in pain.

I believe sleep is supposed to help me heal faster.
–> but it’s hard to sleep because I end up coughing and/or my chest hurts when I lie down (see second paradox)
—–> so I don’t end up sleeping as much as I want to.
Therefore, sleep isn’t helping me get better either.

WHAT DO I DO NOW?!

“Diversity” in med school

The big “day” has arrived; I’m finally in med school in my first year. It’s incredible. For all the awful thoughts I had leading up to (thinking I wouldn’t have any friends, I might fail out, it was the wrong choice), it’s been only fantastic.

Yes, I am lagging on Europe posts. Yes, they will come.

Yesterday was “Day 2” of our “fake” classes (we’re still in orientation). Our lecturer opened with this quote from Thomas Jefferson: “…but health, without which there is no happiness. An attention to health, then, should take place of every other object.” The point was that health is, well, important. Beyond that, we (students, me, lecturer) mostly moved on. My friend I was sitting next to, however, couldn’t settle on that quote. He brought it up as it was happening, and then later last night he brought it up again (I don’t understand how someone could think so long on a quote, but okay, I will go there). So we ended up discussing it, and this discussion brought up some unique points/observations:

  1. Definition debates exist for a reason — what does it mean to be happy? Content? Joyful? (we already chose physical and mental as the types of health)
  2. I’m more “S” than I thought (we just took an MBTI). See my “argument” later.
  3. Re: the title of this post — almost every medical school asks on their secondaries, what can you bring to contribute to the diversity of our school? It was very easy for me to answer that I would bring a patient’s perspective to my colleagues. At the time, I didn’t realize how important that was. I knew on some level that being a patient would give me a unique view on the practice of medicine, but it wasn’t obvious to me how different it would be and that I might actually bring something to the table until our discussion last night (the other two students were, to my knowledge, pretty healthy). The guy I was arguing with was pretty convinced that it was possible to be happy even without health. I agree, but I think it’s a narrow, naive, idealistic way of viewing it. Sure, I can be happy. In fact, I don’t know a single person who would say I’m not a happy girl. But the kind, quality, and level of happiness I feel is definitively limited by my body’s condition, always, and it’s something I never forget. As much as I tried to explain it to them what it feels like to live every day of your life knowing you (1) will never be cured and (2) are always limited in what you can do, I don’t think you quite get it unless you too are sick. So the third guy (other friend present) finally brought up this quote from F. Scott Fitzgerald: “It occurred to me that there was no difference between men, in intelligence or race, so profound as the difference between the sick and the well.” Apt.

As for my S argument, here goes. Assume the state of happiness one feels is on a sliding scale of points, where you can be 0 (neutral), +100 if you are super happy, and -100 if you are super upset. As a healthy person, you have the potential to access +100 and -100 (if we put those at the extremes). Maybe you don’t ever realize that potential, and the maximum you ever hit is +25, but you COULD hit +100. Now say you are sick. You can only hit +50 max now. Why? Several reasons. Maybe you’ve been beyond +50 before, doing something awesome like skydiving or riding a rollercoaster or getting to eat whatever you want, but now because of your health, you can’t do it anymore so you can no longer access +50 and beyond. Or, and this is a bit abstract, you just can’t go beyond +50 anymore because when your condition changed, your perspective changed. I mentioned in a previous post that patients, or at least I, try to rationalize what’s happening to me and cope with it by occasionally poking fun at my disease/body or often engaging in what could only be called morbid humor. In that state of shifting what you think is now “funny”/”okay”, your framework changes. You just CAN’T access +100 anymore. Everything shifts. What might be a +10 for a healthy person (like graduating high school) is a +40 for me because I didn’t think it would happen given my health. What might be a -30 for a healthy person (like getting a minor surgical procedure, getting a flu shot, getting your blood drawn) is a 0 or even a +5 for me because I’m used to this routine but I also think it’s cool (+).

So I’m a happy, sick person. I tend to usually be on the + side of things. I gained a lot from my disease in terms of “worldly perspective” so I know how to make myself happy — maybe I average +30. But I also know that if we went to Disneyland, I still can’t ride the rollercoasters so maybe the max I might get out of Disney is +50 whereas a healthy person could go to +60.

Overall, what I learned from last night is that it really is important to have people of a variety of opinions and backgrounds in your med school class because you will be learning much from them about how you want to practice medicine. People might moan and groan at that diversity essay (I did) but it’s there for a reason.

I’d like to conclude that I have no idea what my opinion is on that quote. I’m pretty sure I agree with it, but I haven’t thought about it enough nor do I care to) to make a conclusion. I only argued to extensively to play devil’s advocate, which is something I enjoy doing (a callback to my high school debate days). What are your thoughts? Do you need to be healthy to be happy?

A patient’s thoughts; memory lane

For my previous post, I dug through some of my old online journal entries, and I found some gems that might show what goes on through a patient’s mind in bouts of depression, attempts to stay normal, with a mixture of self-pity and maybe a touch of drug-induced mania:

“For some reason, I got into a really crazy bio mood yesterday, so I read up on almost everything related to my disease again. All my medications (and all forms of them), all forms of [my disease], etc. Great stuff. Except every time I read any of these things, I always get incredibly sad. I don’t know. Does it make sense that I can feel pity for my sick self? It sort of relies on me separating into two different entities, which sounds really schizophrenic to me.” I agree!

“This is basically a guilt entry to list everything that I want to eat but can’t. xD Hey, it’s a weird way of consoling myself, but if it works, it works: Cheeseburgers, Fries, Yogurt, Macaroni and cheese, Lobster, Lobster bisque soup, Ramen noodles, Chips of every nature, Oranges, Chocolate, Hash browns, Quesadillas, Lasagna, Peanut butter, Omelets with cheese and ham, Milkshakes, Chicken noodle soup” I do recall how desperate I was for these foods…

When I finally got my cheeseburger: “Oh. The best part was that I HAD FIVE GUYS!! I know!! I had to ask for no salt, I couldn’t have condiments/anything added, I took my phosphate binder, and I was only allowed to eat half of the cheeseburger, but WOW, so much love. I’ve probably killed my sodium limit today, but AHH, it was so worth it. Simple pleasures, people, simple pleasures.”

“If you ever want to look like a self-mutilating, anorexic, pregnant woman, definitely get in touch with me. I mean, my goodness. I look like I beat myself or something.” Also see: malnourished African child, Holocaust survivor.

“APPARENTLY, I might be done with dialysis. Forever. Waiting for a call later today. Yay! Also, apparently, because my kidneys are semi-working now, I’m actually not getting ENOUGH fluid? Oy. So now I have to constantly drink water. But that’s okay, because it means I’m getting better, and if I’m getting better, then everything’s okay. Last night I had a hepatitis scare (Francis knows), but it turns out it’s only the dehydration thing. Whew. Yeah, don’t ask how I jumped from dehydration to hepatitis.” I’m not sure how I jumped to hepatitis either but thanks to my friend for being there for me in bout of insanity.

And some on my motivation for medicine: “I’m sure a lot of people here would be surprised to see me sick. And they’d probably say the same thing that all my east coast friends said, something along the lines of ‘you’re so strong’. Really? Maybe. Why is it that when we’re sick we feel this need to make everything normal? Is that how we rationalize things? Kind of like if I pretend I’m okay, then maybe I will be okay? Because I know I try to act that way all the time. But there are moments, moments before I get my test results back, moments when I read about people being sick, moments when I watch anything medical-related, that I get really scared. I’ve still got several years ahead of me before I can say I’m ‘cured’. And I want to be careful so that I will be okay, but I also don’t want these years to just pass me by. I want to be USEFUL. Life is here for us to give it meaning, so I want to freaking give it meaning, not lie around and wait for meaning to come upon me, damn it.”

“On days when I don’t want to wake up because I’m too tired, or when I don’t want to work at all because I’m lazy, I remember people like those in the dialysis center I was dialyzed at. I remember people like Victor. Somehow, in some way, I hope that the lives I may get to save will make up for all of those who lost theirs too early. Somehow, there is karma; somehow, the universe is fair, and for every life that is lost, there is one that is saved. So I get up, regardless of how tired I am, and I keep going.”