In Which the Dam Breaks

Friday, March 29, 2013

NB: This entry contains medical information that may be considered TMI for some. There are no pictures, I promise. Proceed with this knowledge in mind.

I have no delusions that I am what one would call... a tolerant, or patient person. At least, not with regards to my own life. And honestly, I'm not tolerant of a lot of things. I do not suffer fools gladly. At all. In fact, I spend a lot of time ranting and raving about the wanton stupidity that I encounter on a daily basis. What I can say is that given all of my health issues, I feel as though I have been remarkably patient in waiting for appointments, diagnoses, treatments, and results. I have not been completely content through the whole process, but most of the time, I've been able to take it in stride. I've been frustrated and sad and angry, but I've never completely melted down and felt like I simply could not exist in this world. I've always prided myself on trying to have a normal life and continually remind myself that "it could be worse". For the most part, this has worked.

It's been 8 years since the health issues started. In 2005, I was diagnosed with endometriosis and subsequently had a laparoscopy and went on a course of Lupron the summer after my freshman year. For those of you who don't know, endometriosis is a condition where the lining of the uterus goes rogue and decides to grow outside the uterus on the surrounding organs. It's super painful and for many women, debilitating. Fortunately for me, while it was painful, I could still go to class and have a relatively normal life. After the surgery, which revealed "extensive pelvic endometriosis" (which was ablated/removed/etc to the best of the surgeon's ability), my doctor recommended that I go on Lupron, which is a drug that is used to suppress ovulation and essentially put the patient into temporary menopause (it is also used to treat estrogen-receptive cancers, such as prostate cancer, uterine fibroids, and in some IVF patients). It's a pretty serious drug. It's done in either a series of 6 injections, or two, 3-month injections. The injections HURT. (I had a lump on my butt for weeks after each, haha.) The side effects of Lupron are lovely, and include (but are not limited to), headaches, lack of sex drive, depression, hot flashes, weight gain, loss of bone density, mood swings, acne, excess hair growth, and joint pain. I experienced almost all of these the last time I was on this drug. SUPER fun! At this time, I was also prescribed Seasonique, which is an extended oral contraceptive pill (so I only get my period 4 times a year), which helps because fewer hormone fluctuations and periods theoretically means less endometriosis growth.

I was rather fortunate in that I had almost 8 years of symptom relief from my surgery, with my symptoms returning gradually over the last year. The pain was nowhere near as bad as it had been in 2004-2005, and I really only had the second laparoscopy to determine if the endometriosis was back and to remove it if it was. Four weeks ago today, I had my second surgery and to no one's surprise, my endometriosis was back. The good (?) news was that there wasn't nearly as much of it as there was in 2005, and the surgeon (my gyno) said that everything else looked good. They also biopsied my uterine lining (why, I am not sure) but that apparently was normal. After a weird recovery that included band kerotopathy in my eye from the cornea drying out during surgery (OW!) that thankfully resolved itself in 24 hours, wound dehiscence (Dermabond sucks, please suture me next time), and allergies to the bandages (hey there, new-found allergy to Latex...) things seemed to be okay. Then I got my period and it was the worst period I had ever had in my life, but this was apparently normal after one has pelvic surgery. Thanks to Percocet, I got through the week and now things are normal... ish. Minus the parting gift of a yeast infection that my period left me. But that's being taken care of too, so we're on our way to normality for REAL.

Anyway, I saw my doctor last night for my post-operative appointment (and to get this yeast infection cleared up... yay Diflucan) and he brought up that he wants to put me back on the Lupron. Before the surgery, right after the surgery, and even last night, I had told him how much I did not want to be on Lupron ever again. He had given me the impression that it was a choice to be made. Apparently, that is not so, in his eyes. He said that "after everything I've been through, wouldn't I want full relief" and "the reason it was so bad last time was because the last doctor hadn't given me add-back therapy". I'm all for not having endometriosis and taking care of my body, and I'm clearly not averse to medical intervention (Hello, I'm Alison, and I take 14 pills a day, test my blood sugar, and take an injectable medication) but something in my gut was telling me that Lupron was not the best idea. Besides all of the fun side effects I listed above, you also can't take any oral contraceptives (as that ruins the whole "no estrogen, no progesterone" point of the drug). This means you have to use a non-hormonal birth control method (condoms, essentially) which is totally okay... except that I am allergic/sensitive/unable to tolerate any brand, style, material, etc without getting crazy reactions and urinary tract infections. (Hives and pain makes sex WAY less fun. Trust me.) I brought up all of these concerns to my doctor, who brushed them off and said that the add-back therapy would alleviate the side effects and that I "probably wouldn't get pregnant on Lupron anyway" but didn't offer me any kind of solution to my condom conundrum. Sidenote: If you HAPPEN to get pregnant on Lupron, which people have done, apparently, Lupron is a Category X drug for pregnancy, which means SERIOUS BAD NEWS for your impending baby. AND, the Lupron stays in your system for 2-3 months after your last injection, so it can mess with future fertility plans, which is something I just do not need in my life. Great.

I walked out of the office with a prescription for the Diflucan (amen), Lupron, and the add-back therapy, Prempro, and I felt like I wanted to cry. I got to the pharmacy, waited for half of my natural life (as per usual), dropped of my script, went home, and burst into tears. 8 years of dealing with not only endometriosis pain and treatment, but the rheumatological/immunological problems finally came to a head. For whatever reason, I could no longer handle the fact that at 27, I am on 15 different medications. My endocrine system has basically failed me, from the PCOS/insulin resistance, to the endometriosis, and my immune system cannot get a hold of itself. It has been almost 2 years since I've had a month without seeing a doctor, and there isn't a day that goes by that doesn't involve pain or discomfort of some kind. It is getting... no, has been getting OLD for a long time. Last night, upon hearing that I would have to put my body through even more crap, the dam broke. I had had enough.

It seems odd to me to draw the line at what I'll put into my body at this particular drug, given that I'm playing with my insulin system, changing how my body metabolizes cholesterol, suppressing my immune system, and messing with my brain chemistry. Every drug and treatment has a risk/benefit profile, and I've always carefully thought about whether the risk of taking the drug outweighed the risk of not taking the drug (or similarly, if the benefits of taking the drug outweighed the risk of taking the drug). I don't take any of this lightly, and the thought of "What am I doing to my body?" crosses my mind every day. Last night, the stress, the frustration, the anger, and the sadness of this entire situation just got to me. I came home from the pharmacy (where I feel like I spend way too much time), hugged Ken, and burst into tears. Not the cute, girly, tears, either. This was ugly crying. Serious ugly crying. Fortunately, Ken is awesome and just held me. I felt bad because yesterday was our 4 year anniversary (of dating) and we had planned to go out to get cheesesteaks (our first date ever) and by the time I got home and was done having a meltdown (which never truly ended and is still kind of ongoing), I wasn't hungry and it was almost 8:30, so he got some pizza and I ate cereal. Fancy.

But yes. I had basically decided that I would do research today, but that I was leaning towards refusing the Lupron. Of course, I've never really said "no" to a doctor before. In fact, most of the time, I've had to fight with doctors to get them to treat my symptoms. I felt a lot of pressure from my doctor to just do this treatment because it's the "standard of care" and "it's what you do". I definitely want to talk to some of my friends who are OB/GYN's, and I talked to Constance this morning, who is a neurologist, but she made me feel a lot better:

"Stand up for yourself. If you don't want what is honestly an "elective" medication (if for pain control, and it is not worth the side effect profile to you, just say that. . . I love you, don't do anything just because a doctor says to. We're jerks. <3"
I also read a few articles from various journals at GnRH agonists and their usage in endometriosis treatment, and it seems that the only real benefit to using the GnRH is that there is longer between recurrences of symptoms. I don't know how long they followed people for, though, and I've only be able to find studies that went out to 24 months. Last time, I was almost symptom free for 8 years, which is clearly more than 24 months. Whether that was the surgery, the Lupron, the Seasonique (a Combined Oral Contraceptive Pill, or COCP), or some combo though, I am not sure. I did find:

"Other treatments including androgenic agents such as danazol, and centrally acting drugs like GnRH analogs are limited by cost, duration of activity, and more significant side effect profiles, without offering significantly great benefits than the COCP."
That was published as part of a paper in the New England Journal of Medicine, so at least it's probably legit research, haha. Obviously, it's only one paper, but the overwhelming feeling that I get from all of my research is that GnRH agonists are useful, but they do have significant side effect profiles (which I feel as though my doctor downplayed significantly), and COCP's are just as good at relieving pain. The pain, prior to my first surgery, was HORRID. The pain prior to my second surgery was tolerable but annoying, and only during the time that I had my period, which is only 4 times a year. That is something I can live with, I think. At least, I can live with it far more readily than living with 6 months of Lupron insanity. Additionally, since Lupron tanks your estrogen and progesterone, I am unsure what that would do to my PCOS. Argh.

Anyway... it was a hard night last night, and all of this continues to be difficult. I made a therapy appointment for next Wednesday, even though I'm not supposed to see Danna until the following week usually... but this feels urgent. Considering I can't even really think about it without feeling like I'm going to throw something or cry, I need to be able to process this with someone besides my (amazing) friends and in my own (crazy) brain. I am just so angry and frustrated with my body and my life right now that nothing feels right or sane. My health (and lack of it) makes me question so many things, from every day stuff like making plans and whether I'll have enough energy to go out with friends, to long-term concerns, like whether I can go to med school, be a doctor, or have kids and not completely implode. I dream of what it would be like to not be on medications every day, or at the very least, to be voluntarily on them (for birth control purposes, for example). I wonder what it would be like to not have joint pain, or to feel nauseated, or to have my blood sugar freak out randomly. I know there is no "normal" really, but what would it feel like to be "normal"?

I'm very lucky that I have amazing friends (some of whom are great physicians, too) who are there for me when I have these meltdowns. Also, Ken is pretty much the best husband ever and I don't know what I would do without him. I often feel like an alien in this world of chronic disease, because until very recently, I didn't/couldn't/wouldn't admit that I even had a chronic disease. There's so much information (and misinformation) out there, and it is hard to sort through it all. As per usual, I want all of the answers RIGHT NOW (ANSWER ALL THE QUESTIONS!) and all of the solutions (FIX ALL THE THINGS!) and unfortunately, that is just not going to happen. Sigh.

At least it's Friday and the weekend ahead looks lovely. Tonight, no real plans (yay!), tomorrow I will be studying for the GRE (lame), and then Ken and I are going to dinner with Victoria and her husband Vinny, and Alicia and her (new) fiance, John. Sunday... not much going on except that we're going to dinner at my mom's with Levi. Looking forward to sleeping in, baking, relaxing, not doing laundry (because I did SO much laundry this week that there is almost none left to do), and basically trying to put my brain on vacation. 

OH. Before I go! I got an invitation to interview for the post-bac program at Johns Hopkins! I got the email today and I have to email the director of the program back and let her know when I'm available. Holy crap.

I think that's all of my news for now. That is certainly more than enough.

- A

In Which I Contemplate the Date... and Other Things

Friday, March 15, 2013

For those of you blissfully outside the medical school world, today is March 15th and nothing more.  Well, it's probably someone's birthday, and I guess it's also technically the Ides of March or whatever, but to most people, it's the 15th and we're all very excited that it's Friday. To 4th year medical students all over the country, it's Match Day. Today is the day that the doctors-to-be are told where they'll be spending their intern and residency years. It's pretty much the most important day in a medical student's career. The second most important day was Monday, March 11th, which was the day that everyone finds out whether they matched, and today is the day they found out where.  Obviously, not everyone matches, and that sucks... but this week is mostly a very exciting, joyous time for 4th year's everywhere.

This time last year was one of the worst days of my life. It would have been the day that I would have (hopefully) matched, had I not left medical school in 2009. As I watched some of my best friends in this world match into their residencies, I put on a brave face and congratulated them because seriously, what an accomplishment! I was so proud of them for getting to this place in their lives and I knew how happy they were. I was also filled with a heavy sadness, because I wasn't there with them, opening envelopes and celebrating. And I knew on some level that even if I had stayed, there was no guarantee that I would have matched... but the fact that all of these people were doing it and I was sitting in my office (at a job I hated where I made next to no money) was seriously disheartening. This was before I had even decided that I wanted to go back to med school, and actually, I was still in my delusion of "I never wanted to do that anyway" (ha ha, I am so funny sometimes). I didn't expect the feelings to be as bad this year, but guess what?

They're worse.

I guess part of it is because I'm still not over what happened in 2009. For those of you who are playing the home game and are unaware of the 2009 incident, here's the quick recap. I graduated from Drexel in June of 2008, and 6 weeks later, I moved to Fort Lauderdale, FL to start med school. I moved in with a guy I had been dating for a little under a year, even though I didn't really want to, but I was too scared to break up with him before I left and I figured it would work out (Spoiler alert: It didn't). I started classes in August, broke up with the guy that had moved down there with me, made some friends, and started dating a guy that I had no business dating (seriously, he was SO wrong for me). The anxiety and depression that had been previously pretty controlled spiraled out of control, and soon I was on 5 different psych meds just so I could function, and I wasn't even doing that very well. My test anxiety was so terrible that I was leaving the room to vomit in the middle of exams, and the night before an exam, I would be unable to sleep unless I knocked myself out. I had debilitating migraines, I was exhausted, and I hated my life. It got to the point where every day, when I walked to class from my apartment, I hoped that I would get hit by a car while crossing so I wouldn't have to deal with this anymore.

I ended up just barely failing both my Gross Anatomy and Physiology classes by 4 and 2 points, respectively, so I knew I would have to retake them that summer. As I started second semester, the guy I had no business dating unceremoniously broke up with me during lunch, and a few weeks later, the Dean of Students pulled me into her office to ask if I was okay. I tried to lie, but I'm sure they didn't make her the Dean of Students for no reason, and she could tell I was in trouble. I asked how one would take a leave of absence from the university and she said that it was really easy. I said I'd come back to do it, and she marched me out of her office, upstairs to the Dean's office so I could sign the paperwork. She told me to go home and rest, and to come back when I was well. She was my savior, because I don't think I could have made the decision without a strong push from someone who knew me and knew what they were talking about. Just like that, I signed away the life that I had put every ounce of my being into, and now I had no idea what to do.

At first, I just slept. It had been so long since I had any decent rest that it was all I could do. But without a need to go anywhere or do anything, I soon took to my bed all the time. I half-heartedly applied for secretarial jobs, because on some level, I wanted to stay in Florida. On the other hand, I wanted nothing more than to go home to New Jersey to hide and pretend this entire experience had never happened. Without a purpose, my depression became even worse. I cried all the time and felt like the world's biggest failure. I had no direction, no goals, and no idea what the hell I was doing with my life. One night when I was on the phone with my mom, I told her that I wanted to take all of the pills on my nightstand, and it was one of the scariest nights of my life. From 1,200 miles away, she convinced me to call my school's crisis line (and I only called because she threatened to call my father and the police if I didn't call the crisis line). As soon as someone says that they're suicidal, the crisis center sends the cops. I hadn't left my house in almost 2 weeks, I had barely eaten or showered, and I certainly hadn't gotten out of my pajamas. It's strange what goes through your head when you're that depressed, and I remember thinking, "I should really get dressed so when the cops get here, I'm at least wearing a bra". When they knocked on my door, it was about 10:30 at night, and they asked me if I had any weapons. I said, "No, but I have two cats," which I'm pretty sure confused them and also confirmed that I was in dire need of assistance. They came in, checked me out, looked at all of my pill bottles, and said that they were going to take me to the hospital. Sitting in the back of the cop car, I burst into tears and called my mom to let her know what was going on, and she called my dad and step-mom.

The cops dropped me off at the general ER, which was the wrong ER because apparently, there is a psych ER for these kinds of things. I was so dazed at that point that I couldn't even understand the directions that the nurse was giving me for where I had to go, and I'm pretty sure you're also not supposed to send suicidal individuals off by themselves, so I asked for someone to escort me over there. At the psych ER, they took all of my things (including my bra) and drew blood (I guess to make sure I wasn't on illegal drugs or dying of an overdose) and then an older nurse from the islands talked to me for a really long time. His accent was so thick that I could barely understand him, but it's kind of like when you talk to a puppy. They have no idea what you're saying, but as long as it sounds nice, they're pretty happy. My dad and step-mom arrived and I still couldn't stop crying. The nurses admitted me and took me up to the behavioral health floor, which locks from the outside (not unnerving at all, ha ha). They didn't have a regular bed for me, so I slept in one of the solitary rooms that they put people in when they're a danger to themselves (it also locked from the outside, but they left it open for me). I cried all night until I fell asleep, and then spent basically the next 4 days doing nothing but crying. The next day,I moved into a regular room with another girl, and I started going to the group therapy sessions (which were useless). I was one of the youngest people on the ward, and also, someone, one of the sanest. My dad came to visit me every day and brought me tons of magazines to read, as well as sweat pants, a t-shirt, and a sweatshirt, because the only things I had (jeans, etc) were taken from me and I didn't want to wear a hospital gown forever. I had a horrible psychiatrist who didn't listen to me, and he took me off of all of my meds without weaning me, which led to withdrawl symptoms that were so bad I felt like I wanted to die. I shook like a Parkinson's patient and had horrible headaches and brain zaps, and the medication they put me on made me throw up all the time. I lost 12 pounds in 4 days (this is not a diet I recommend). Constance and some of my other friends came to visit me, as well, and my friend Michelle brought her therapy dog, Byron, to see me. I felt bad because I hadn't told any of my friends what had happened or where I was going, and I wasn't allowed to have my cell phone. My car was still in front of my apartment, so Constance assumed the worst and was about 3 seconds away from breaking down my apartment door to see if I was dead. Luckily, someone had seen a vet bill with my mom's phone number on it in my car, so they called her and she told them what was up.

After 4 days, they let me go home. I spent the first night out at my dad's house, still incredibly nauseated from the meds (that I immediately stopped taking once I left the hospital). I flew two days later, still mostly dazed and unable to make any decisions whatsoever about my life. My mom and my Aunt Kathy devised a plan to get my apartment packed up and moved back to NJ, so I flew back to FL and a day or two later, my mom flew down. She basically packed my entire apartment and flew home with one of the cats. My aunt flew down from Baltimore, helped me pack my car with stuff and the other cat, and we drove back to the northeast over 2 days. The only good thing out of all of this was that my aunt and I really had a good time in the car and connected on a really deep level, and we remain really close. When I got home, I basically hid from the world for a couple of weeks. Eventually, I got a job as a unit secretary again, I started dating Ken (and we all know how that ended up) and got into my MPH program. It seems like I got a happy ending to most people, and in some ways, they're right.

So... that wasn't a very quick recap, but it's a lot quicker than the time it actually took to happen, so just be glad that you didn't have to live it (seriously). Anyway, it's been 4 years since that mess and it still feels like only yesterday that I walked out of the Dean's office and away from my life's dream. For a very long time (almost 4 years) I lied to myself and said that I didn't want to go back to med school, and that I never wanted to go in the first place, and clearly, the entire thing had been a giant mistake. As it turns out, I'm a terrible liar, even to myself, so this year, the truth finally emerged and poof, I'm attempting to return to med school. I should be ecstatic! Instead, I want to hide under my kitchen table or in bed (my go-to spots when I feel as though the world is ending). Fortunately, I haven't given in to those whims and desires, and instead threw myself into applying for post-bac programs, retaking the GRE (ugh), and planning to retake the MCAT (I should seriously schedule that... double ugh). So, the second part of why Match Day is so hard this year (to connect back to the original purpose of this post) is because I am now so ready to go back. Now that I've identified that yes, this is what I want to do, the fact that I have to wait another year (at least) is actually painful.

The plan is to reapply to DO schools this June/July, because my GPA isn't SO terrible (it's a 3.1) that I couldn't get in, probably. I'll also retake my MCAT at that point. Hopefully, I'll be starting post-bac classes then as well, so my GPA will continue to go up as I'm waiting for med school stuff to get figured out. If I don't get in for Fall 2014 (which is entirely possible), then I'll finish my post-bac in the summer of 2014 and have to find a job for the year while applying to med school AGAIN for the fall of 2015. I know, it's all very confusing. Basically, I am praying that I get into med school for Fall 2014 because otherwise, I have to find something to do with myself for a year in between when I finish my post-bac and when I can (hopefully) go to med school. And then there's the question of WHERE will I be doing the post-bac?

For once, I'm not concerned that I won't get into a program (at least, not really concerned... there's a part of me that is a spaz and will always worry about not being accepted), but the where is still up in the air. I applied to Drexel and Temple, and as soon as I finish this last essay, I'll be applying to Penn. All three of these programs are certificate programs, so there isn't a degree attached to their completion. The one at Temple is attractive because it's only ten months and if I hit the marks for their GPA and MCAT, I can go to Temple Med in 2014. I applied to Johns Hopkins University's MS in Biotechnology - Health Science Intensive program, which is a 1 year MS degree. I also applied to 3 programs in FL that are similar, including one at FAU, one at Barry University, and one at the University of Southern FL. Every program still has some outstanding requirement for it... but they're mostly letters of recommendation, which I'm politely harassing people about today. The only other thing that's missing are my GRE scores, but that's because I have to retake the damn things on April 6th.

But yes, the fact that we could either be staying in this area, moving to MD, or moving to FL is all kind of terrifying. Drexel and Temple start their programs in the fall, and at Penn I could start in the summer or the fall. JHU starts in early June, I think that FAU and USF start in the summer as well, and Barry starts in August. So... it's all kind of soon. And between now and whenever I start, we'd have to move and Ken needs to make sure he's certified to teach and then holy crap, he needs to get a job and... yeah, it's kind of all terrifying. I wouldn't mind staying here (at least, not too terribly) except that I'd rather be in a program that grants the MS degree, rather than a certificate. Sigh... so much to think about!

Anyway... I am going to try not to worry about it too much (which will probably be next to impossible) and this weekend, I am going to try and relax. Tonight, Ken, Levi, and I are going to an Irish pub in Center City b/c my friend Liz (of APW and Happy Sighs) is shaving her head tonight for the St. Baldrick's Foundation. Then tomorrow... cleaning, GRE studying, laundry-ing, and possibly seeing a movie. Sunday, Lindsey and her boyfriend John are going to come over and we're going to hang out and watch Cabin in the Woods (hysterical!) and it should be a good time.  For now... I am getting the heck out of here because it's Friday and my brain feels like it's going to melt out my ears. Have a good weekend, all!

- A

In Which I Talk About My Brain

Wednesday, March 6, 2013

I swear, the minute my head hits the pillow and I turn out the lights to go to bed, my brain decides to go into overdrive about all of the things that could possibly affect my life. It especially likes to bring up all of the doubts, fears, worries, and concerns I have about possibly screwing up my life (and, subsequently, the lives of others). I guess all day, my brain is busy doing other things, so it can't be bothered to ponder the ultimate demise of all of my hopes and dreams.

Things had been going pretty well in my brain, recently.  I made the decision to apply to post-bac programs and to retake my GRE (okay, that decision was kind of made for me), and to eventually retake my MCAT this summer (?) and go to med school (???). I was actually feeling kind of empowered, like I could totally do this thing that I had decided to do, as crazy as it sounded. And then, stupid things creep into my head. It will be something innocuous and small, like a friend posting that she felt like crap but had to go to rounds, and then I'll start to think, "I'm sick all the time, what if I can't finish med school, let alone be an actual physician?" Or someone I know just had a baby, and I start to wonder if I'm ruining my chances for having a family because now I'm going to be in school for the next 5+ years.  A bunch of my friends are house hunting, and I wonder if I'm financially screwing us forever by going back to school.

And then I start to think, "Maybe I can just make myself be happy doing what I'm doing," and I ponder that.  My job here is pretty easy, and the people are nice. It doesn't mentally thrill me, or make me particularly happy, but... maybe that's okay? If I stay here, will I spend the rest of my life wishing I had taken this opportunity to go back to school when it "made sense" (even though it doesn't really "make sense" now either). Life is constantly pushing us forward, onward, ahead. The time for me to have gone to college and med school seems to have come and gone, at least practically, and while yeah, you can go back whenever you want, at what point does it become stupid? I feel like I'm on an express train and I just realized that my destination was three stops ago and now I can't go back. I feel like I have to give up one dream for another. I feel like my dream of being a physician is completely and totally antagonistic to my dreams of having children and buying a house. Obviously, lots of other people, many of them my friends, have done this or are actively doing these things all at the same time... but they started when they should have, not when the world stopped spinning long enough for them to get their feet under themselves and say, "What do I want out of life?"

I never stopped wanting to be a physician. Even when I lied to myself every day and said, "I never want to go back to med school, I never want to be a doctor," somewhere inside of me, a seed of truth was germinating and refusing to be stamped out. And now I don't know what to do with it. My list of "things I want out of life" is constantly shuffling in priority, and what I think is a priority isn't what society thinks my priorities should be, and for once, society isn't completely out of line. I'm 27, which yes, is young.  But if I go to med school, I'll be starting at the VERY earliest when I am 28, in 2014.  I'll graduate in 2018, making me 32. That is ALSO not old, but then I have to start a residency, which takes me at least to 35. One can totally have kids in residency, which at that point, would basically be my only option, because while lots of people have kids in their late 30's and into their 40's, I would rather not do that to myself and also because who knows if I can even have children (thanks endometriosis/likely PCOS) so that's fun.

And that's just part of it. There's also the (far more important?) financial aspect of this entire endeavor. I already have a significant amount of educational debt (like, $200K, ugh) and this would certainly cost me another $200K at least, not to mention that we'll go from being a 2-income household (with a decent amount of savings) to a 1-income household with little to no ability to save. Ken makes a decent salary, but he is a public school teacher, so his salary only grow so much at a time, and that's debatable in this economy. We clearly wouldn't be able to buy a house, or take vacations, or do anything that anyone else in our age bracket is getting to do, all because I chased some dream about being a doctor when I had a perfectly good job.

So now I don't know what to do. I'm sure I'll talk to Danna about it next Wednesday, and I'll definitely talk to Ken about it, since it affects him the most out of anyone (besides me, I guess). I wish that I could cut out the part of my brain that wasn't happy doing what I am doing, the part that wants to be a doctor. I wish that I hadn't wasted my time getting my MPH. I wish that I could just be content to continue the way we are, heading towards stability and normalcy. I wish there was a way to know that if I decide to give it up, that 5, 10, 25 years down the line, I won't look back and say, "Damn, I should have done it."

But there isn't.  There isn't a way to do any of those things. I guess at some point, I have to stop thinking and just DO something, but until I get to that edge, I'm probably going to just keep vacillating between the two options. Until someone or something makes me jump, I'm stuck staring into this crevasse, wondering how far down it goes.

At the very least, I'd like to figure out a way to get my brain to shut up, so I could get some decent sleep. Since a frontal lobotomy is frowned upon, I guess I'll have to go the route of deep breathing and Benadryl.

And then life hands you random things, like my friend Rachelle (check her out at Well & Lighthouse or By the List) IM'ing me to tell me about a new artist she thought I would like, Amy Wood. Large and proudly displayed in the middle of her home page?


Well okay, universe.  I guess it's my move now, huh?

- A

In Which I Convalesce

Saturday, March 2, 2013

Sometimes, I am really bad at doing nothing. Don't get me wrong, I can sleep in with the best of them, and I love a lazy afternoon. It's when I am forced to do nothing, or it turns out that there is nothing to be done, I go nearly insane. I had a laparoscopy and hysteroscopy yesterday, which are fancy ways to say that my gynecologist looked inside my pelvis and abdomen with a tiny light through incisions in my abdomen, and also checked out the inside of my uterus.  In 2005, I had my first laparoscopy and was diagnosed with endometriosis. For the next 7 years, I had minimal symptoms, but the last year had gotten worse and so my doctor wanted to check everything out.  Fortunately, the endometriosis was way less severe this time around than the first time, and by visual inspection, the interior of my uterus looked normal (we'll have pathology results back in a week or so).  The surgery went fine, and thankfully, I didn't get negative pressure pulmonary edema this time around (unlike the last time I had general anesthesia... which was super fun).

Of course, this time has not been without its own drama.  I woke up from the anesthesia in the recovery room and my left eye was really itchy and dry.  I asked the nurses flush it with saline, which helped a little bit, and later I had cool compresses on it to try and alleviate the pain.  I thought that maybe my eye was just dry, so after I showed the nurses that I could eat, drink, walk, and pee, I was allowed to go home.  My mom had driven me, and on our way home, we stopped at CVS to fill my prescriptions for various pain killers and antibiotics.  I almost passed out from standing in line, which led to me laying on the floor of the pharmacy, always a good time.  I got home, Ken put me in bed, and I tried to rest.  My eye only got worse and the pain was practically unbearable.  I felt like there was ground glass under my eyelid, and everything I tried made it worse.  I finally called my optometrist to see if I could get an appointment (I could not) but he told me to email him and he'd get back to me with suggestions.

His response was that I either had a corneal abrasion (in which case, I would not be better in the morning, and I would probably be worse) or the epithelial layer of my cornea had dried out during surgery and that was causing my pain. Apparently, it takes 12 hours for the cells in the epithelial layer of the cornea to regenerate, so my doctor recommended that I use gel eye drops and rest, and if I didn't feel better in the morning, that I should come in. Thankfully, the gel eye drops gave me enough relief to sleep and in the morning, I woke up and the glass-in-my-eye feeling was gone.  My eye is still swollen from all the rubbing, but I'm glad that the eye pain is gone.

My abdominal/pelvic pain has been okay, but not great.  The T3's (Tylenol with codeine) is helpful, but I still have some pain, especially about 2 hours before I'm supposed to take the next dose. The surgical incisions are small, about an inch, and were closed with Dermabond, which is basically superglue for skin. Of course, the Dermabond for my incisions came off, so now I have them closed with butterfly bandages.  I called my surgeon twice to see what I can do, but he hasn't replied yet.  I'm guessing that it will be fine (???) and I have to call on Monday anyway to make a follow-up appointment.  I'm friends with his receptionist on Facebook (haha), so I messaged her to see if she knows how to get a hold of him.  At least I'm not bleeding all over the place...? Nothing is ever simple with me, haha.

But yeah, I'm kind of going insane having nothing to do.  I'm too sore to really do anything, but I feel bad not helping Ken clean or cook.  He's been completely amazing, having run to the store a bunch of different times now to get me juice, gel eye drops, and butterfly bandages.  He's also done all of the dishes and the laundry, and is going to start vacuuming soon.  He has sent me back to bed each time I've tried to get up and has been super attentive.  I seriously don't know what I'd do without him. :)

In other news, all of my post-bac applications are in except for Penn.  I have a bunch of essay-type questions to answer for that application, and I think I can basically use the ones that I've already written and change them up a bit.  It's not due until April 1st, so I have time.  I randomly decided to apply to Johns Hopkins post-bac program, as well, so... yay? I found out that I have to retake my GRE (blergh) so I'm registered to do that on April 6th.  I took a practice test and did really well on the verbal section, but not so great on the math (it was rather abysmal).  Luckily, I live with a great math teacher, and I'm pretty sure free tutoring is a marriage benefit. I bought a prep book that has 5 more practice tests, so I should be ready by the 6th to at least get a score that's decent enough to get me into a post-bac program.

Other than that, not much is going on.  Work is work... I obviously took yesterday off, and I plan to work from home on Monday.  I can't spend too much time upright yet, and my pain prohibits me from walking around for too long.  My managers are awesome, though, and I have plenty of paperwork to keep me busy from bed.  I have to work on an IRB amendment (ugh) and I have plenty of data entry to do.  I'm more than happy to sit at home and do it, where I can take narcotic pain killers and stay in my pajamas. I am extremely grateful for a job that allows me that kind of flexibility when I need it.

This weekend is obviously shot, as far as productivity or plans are concerned, but the weeks coming up should be pretty filled.  This week, I have an appointment with the new endocrinologist at Penn, as well as an appointment with my new GP (a different, new, GP than the one I saw last month, haha).  Ken is going to NY from Friday-Saturday, so I am making plans with some people.  Friday, I should be seeing my friend Lauren, and then Saturday, my friend Amy invited me to a sex toy party (if you don't know what that is, it's like a Tupperware party, but with vibrators, haha), so I'll probably stop by there for a bit.  Sunday, not sure what's going on.  Probably relaxing and attempting some productivity.  The week after that is only exciting because we're getting our taxes done (yay refund, hopefully!) and then I'm seeing Colleen that weekend.  Then the NEXT weekend we're going to Florida for my dad's wedding!  I need to figure out which dress I'm wearing, or if any of my dresses that are appropriate for the occasion actually fit.  It's very casual, so I'm thinking everything that I have will be too formal, since they're all cocktail dresses, basically. (Unrelated: Every time I've seen "cocktail" written out lately, I first think it's "cockatiel" which is awkward.)  Anyway, I may need to go dress shopping, so that could be fun/annoying.  I'm excited to go to FL for a few days though.  We might even go scout some apartments, since it's kind of likely that we'll be moving there for my post-bac.  Who knows, though?

There's a part of me that really wants to move down there, and a part of me that is absolutely terrified.  I would love to be closer to my dad, in a climate where going outside doesn't make me want to instantly cry.  Also, I like palm trees.  A lot.  And it would be nice to be farther away from my mother.  I would definitely miss my friends that are up here, but so many of my good friends are all over the country anyway.  On top of that, Ken and I never planned on staying in NJ.  Ken doesn't seem to have an inclination to go anywhere, except maybe back to NY, but we both know that's not happening because it's too damn expensive.  Other than that, we would probably be equally happy anywhere, and I know that I want to be in Florida.  I guess we'll see what happens...?

On that note, I'm going to go back to resting, reading, GRE-ing, and possibly eating ice cream (since I was successful in eating dinner tonight!).  Have a good weekend, everyone!

- A


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