Tuesday Chaos, Wednesday Confessions

Wednesday, August 20, 2014

Well, yesterday was a day. One of those days. One of those days where you hit your snooze button and wake up not 10, but 30 minutes later. One of those days where you get dressed and then realize that you got God knows what kind of hair product on your shirt, so you have to change. One of those days where you try to go downstairs not once, not twice, but three times, before successfully making it down without forgetting something. One of those days where, when you have to go back upstairs for what feels like the 93rd time, you trip and almost smack your head on the hardwood, because clearly, you can't handle stairs at 28. One of those days where your lunch is yogurt with granola and grapes because you didn't get it together and pack your lunch the night before. One of those days where you put on your make-up in the car. And your deodorant.

Just one of those days. And man, was it long.

So far, I've learned the the fastest way to freak out 162 med students is to:

A. Not post slides before the lecture
B. Skip slides that are in the lecture, or talk about slides that aren't in the ones on the website
C. Have conflicting information on various schedules
Basically, we're a bunch of Type-A, overly obsessive, control freaks who don't want to look stupid and need to know what's going on at all times, or we all have meltdowns. At least... that's how I am, and how it seems a majority of the medical students that I've met (both here and elsewhere) react to situations like this. However, this situation did create a pretty hysterical conversation among some classmates and myself. Our online schedule said that today, we had small group work from 1-2:30 and a patient panel from 2:30-3:30, but it also said we were splitting into two lab groups (one from 2-3:30 and one from 3:30-5) and meeting in the lab. For patient panels, we have to wear our white coats, but for lab we have to wear gym clothes. Insert mass chaos here.

Someone had asked if anyone knew what was going on for class and the responses included guesses at interpretations of the schedule, which were helpful, as well as the far less helpful but far more amusing answers:

"To clarify, no one knows if we have to wear loose-fitting clothing tomorrow?"
"Wear all the layers you can."
"Patient panel, lab time, group work... FOLLOW ALL THE PROTOCOLS!"
"I think the conclusion drawn so far... no one is 100% sure that we have lab tomorrow."
"TLDR; mass chaos will ensue tomorrow from 1-5. Plan accordingly."
"Gym clothes under your dress clothes under your white coat, right?"
"I thought white coat underneath?"
"We have some of the 161 of the smartest minds in the country in this group... how do we not know what to wear!?"
"When in doubt, just the coat."
"Coat only? How scandalous."
"Well, that would make OMM easier..."

Because I am a neurotic disaster, I actually broke down and emailed one of the professors because I was tired of not knowing, haha. I never got a response, but it turned out that (not surprisingly) it was way less complicated than we thought it would be, our professors gave us directions as we went along, and no one was drawn and quartered for not having their white coat for the day's patient panel. 

Other chaos that has begun ensuing is my frantic attempts to organize my studying. I had to study in my post-bacc, but there obviously was a smaller volume of information to be assimilated at one time. I know the phrase "drinking from a fire hose" is overused in this arena and some people don't like it, but I still think it's an incredibly apt metaphor to describe how med school feels from day 1. I've also heard it described as "finals week, every week" which also is pretty close to the intensity one feels while attempting this crazy experience. Basically... it's hard. Really hard. (Duh.)

Monday was the first night I realized how my health might affect my ability to study. I've studied while tired before. I've even studied while acutely ill before, with a fever and in between laying on the bathroom floor from vomiting. Monday was the first time I was attempting to study with pericarditis and pleuritis. I say "attempting to study" because I really wasn't getting very far. The only way I found myself able to breathe deeply was to bend forward at the waist, which, as you may imagine, is not exactly optimal positioning for reading, typing, or writing. I also felt like I couldn't catch my breath, so every few minutes, I started to feel light-headed, which led to me laying my head on my desk and waiting for the spots before my eyes to go away. Then I started coughing and felt like the lining of my lungs was going to be ejected onto my notes, which wasn't going to help anyone. Add to that the bonus of my hip bursitis having returned with a vengeance and I was one unhappy camper med student.

Sidenote: If campers are so unhappy, why does anyone go camping? I can't remember when I've ever said that something made me a "happy camper". Perhaps there are campers out there that are simply overjoyed, but I am not one of them. Camping makes me itchy. 

Okay, anyway... Monday night, not fun, no bueno, called it a night at 11:30, self-medicated with prednisone that I had on hand, refilled my Medrol dose-pack, and went to bed. Laying down and going to sleep was hell, but eventually, I fell asleep... probably around the time that the prednisone kicked in. No lie, when I woke up Tuesday, the first thing I said was, "You know what's awesome? PREDNISONE," because I could breathe without pain. I have an unfortunate feeling that there is going to be a lot more prednisone in my future. Ugh. By the way, take a moment and thank your lungs and your heart for functioning optimally and without pain. Do it, I'll wait.


Right, so, Tuesdays are the only day we have class at 8 am (thus far) and into the afternoon, although we're usually finished by 4ish. We started with a thrilling 2 hours of genetics, during which we somehow blew through 90+ slides on clinical cytogenetics. The only thing it succeeded in doing was making me pine for Kristin (my CHOP officemate), who basically taught me everything I know about genetics and genetic testing. Subsequently, I pined for the days of my 9-5 and the office Keurig and having any number of delicious (and unhealthy) food options outside of my office door... but then I remembered that the job itself kind of made me want to punch people... but I still missed Kristin. We followed that up with 2 hours of rapid-fire biochemistry, where an excitable Chinese man shouted about TATA boxes and TTGACA boxes and promoters and who knows what else. Have I mentioned how much I really hate molecular bio? Because seriously? Molecular bio can blow me.

Then I did the lunch thing and sat at the Student Pediatric Medical Association Table to sign people up for the flag football tournament that's happening on Saturday (for charity!), talked to a second year in peds club about how not to fail the first biochem exam (whee) and tried to answer 94 questions about what the hell was going on that afternoon in OMM, because apparently, I look like I know what's going on. (Spoiler alert: I do not, I just pretend.) Then we had OMM... and then I got derailed by a patient panel.

This is the story of how I started crying during a med school lecture, and not because I thought that I would never remember the enzymes used in the tricarboxylic acid cycle or because I failed an exam. No, I cried because, as per usual, I just have a lot of feelings.

Today's patient panel was made up of patients who are seen in the OMM clinic here at the Neuromuscular Institute, which also houses pain management, a headache center, and orthopedics (I think?) They're all treated for chronic pain, either from injury or long-standing issues. There were two particular patients that really sent me over the edge. The first was a young woman, only a few years older than I am, who woke up one morning with intractable back pain. She went through doctor after doctor, treatment after treatment, never getting answers or a diagnosis or relief. She was told over and over again that there was nothing wrong with her and that there was nothing that could be done for her. A physiatrist even told her that what she was feeling (she reported that her entire body hurt) was impossible. How much more dismissive can you get??? Her story mirrored my own experience with chronic illness (and whatever this autoimmune disease is) that I just got very overwhelmed. Fortunately, this patient found a great team of doctors here at the university and she feels like she's finally on the right track to getting well again. 

The second patient was a woman in her mid-30's who had a few injuries from car accidents that started her pain. She also went from specialist to specialist, dealt with the haze of narcotic pain killers, and lost 3 jobs due to her inability to work through or with the pain. She was admitted to a psychiatric hospital because she was suicidal. She talked about how physical pain, day in and day out, can and does lead to depression. Life feels meaningless because the life you had before is over and this new life doesn't have much going for it. Another patient said, "Either come here and kill me, or do something about this pain. Who wants to live like that?" She started to talk about how one of the physicians here helped to save her life, and at that point, I lost it. I managed to not ugly-cry, but it certainly looked like my face was leaking. I guess that makes sense, because it was.

The patient also mentioned that people don't understand chronic pain, because it's not like the patient is always outwardly exhibiting signs of injury or illness. Instead, many of us look "totally normal" and can have what appear to be normal jobs and normal lives. What the world doesn't see is that every step we take from the car to the door feels like a mile, or the pain patches hiding under sleeves, or the haze of narcotics or the cloudiness of brain fog, either from pain or the disease itself. They don't see the depression, the anxiety, the grief over a life changed by pain. They don't see the 17 or 20 pills you might take every day to manage symptoms. What they see is a carefully choreographed routine of how to do things so that they hurt less, and how to hide it when it does hurt. What they do see is that someone might have a handicapped placard, or take the elevator one floor, and when they make a snide remark about laziness, they don't see how much it hurts and how much you want to shake them and tell them that they have no idea what it's like.

I don't know why, but I was just overwhelmed with emotions. I was sorry for the pain these two women had endured, both physiologically and emotionally, because no one wanted to help them until years after the needed it. I felt anger and sadness for myself, because I am still fighting to have my concerns met, and I routinely feel that my pain and other symptoms are illegitimate because I can go to school and work and go out with my husband or my friends. Like in order to deserve treatment, that I must act sicker and frailer. I refuse to give up the life that I have fought so hard to obtain; I refuse to lay down and let my life go on without me. After all, better living through chemistry, right?

And at the same time, I felt inspired. I felt hopeful. I felt right. I felt like if I can be a physician for patients who feel unheard and unseen, then I am doing my job. If I can help navigate the waters of vague diagnostic tests and symptoms that greatly affect a life but don't add up to a diagnosis that we can put into a nice, little, box with an ICD-10 code, then I am doing my job. If I can help someone realize that life is not meaningless, and that there is life beyond daily pain, then I am doing my job. I want to teach patients to advocate for themselves, to take responsibility for their own health, and to become a partner with their physicians in their healthcare. I want to be one of the physicians that these patients talked about, who take care of their patients in body, mind, and spirit. And yes, I realize this all sounds incredibly cheesy, but I really wasn't lying when I wrote my personal statement. Hand to God.

I hope that in 2 weeks, when I'm up to my eyeballs in studying, probably having a meltdown of some kind, wishing that I was back in my quiet office with my IRB amendments and my consent documents, that I can remember the reason I'm doing this. Someone remind me, okay? Good.

And since it's been awhile, let's throw some Wednesday confessions with Kathy of Vodka and Soda in there for good measure.

Vodka and Soda

So what am I confessing this week?

- I don't hate studying. Yet. That will probably change. But I really like using my brain. Who knew?

- A classmate hugged me today and it was awesome. Thanks, classmate.

- I am meeting new people every day and I guarantee that I won't remember half of their names. Sorry, guys. Nothing personal. (But I promise I won't call you Anfernee.)

- I have been pleasantly surprised by the reactions and reception that I've gotten when I tell classmates that I've done the med school thing before. So far, no one has looked at me like I'm some kind of zoo animal, although who knows what they're thinking once they walk away. In any case, they all seem to be totally cool with it, so... hurrah for people being reasonable humans for once.

- I already confessed this, but I totally cried during lecture today. Also, I am a big sap who, when she lets herself, really does feel like this is a good choice. "This" being medical school. That it makes me feel warm and fuzzy to think about doing this for the rest of my life.

And now that I've expressed my many feeling sin the form of Mean Girls and Easy A gifs, I am going to go take some more prednisone and... study? I guess? There's always something else to read and attempt to cram into my brain now. Tomorrow we have 2 hours of histo and then 4 hours of "On Doctoring," which is our clinical course. I don't have class until 10, but I absolutely must get up and attempt to renew my license at the DMV tomorrow before lecture.

So yeah, maybe I'll just take my plethora of feelings and go to bed. I'll leave you with this quote from Pam, because it makes me laugh.

"How can such a tiny woman have so many feelings?! Did they take the water out of you to make room?"

All good questions, Pam. All good questions.

- A


  1. If you start missing consent documents and IRB amendments, you'll have officially gone 'round the bend and I'll have to have a very serious talk with you. No one misses those things. NO. ONE.

  2. You can do it! You got this! It'll be okay. Now that you've had one of those days, you're due for an awesome one, right?

  3. Oh lord, this sounds so stressful! I have confidence you can do it!!

  4. Thanks! It's stressful, but... dare I say, almost enjoyable? :)

  5. That's what I"m hoping for! :) Thanks for the vote of encouragement. It makes all the difference to have a group cheering for you!

  6. Haha, okay, you're right. When I really thought about it, I was really glad to not be working on any of that crap!


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