Confessions and Questions

Wednesday, February 25, 2015

Happy Wednesday, also known as, "Oh my God, I have 45 hours until my exam and I am not ready so I am freaking out." It's also time for Hump Day Confessions. WHOO!

I confess...

... I just gave myself more work to do in the way of a summer research fellowship application and due to poor planning, is going to probably give me an ulcer because it's due Monday. GO TEAM.

... I had a dream about diagnosing and treating rib dysfunctions with OMM. When I woke up, I was mad because the treatment I had done in my dream was wrong.

... I have to read 5 papers about hermaphroditic nematodes so I can write a proposal for said research fellowship. I am stoked! (#sarcasm)

... I ate pizza for dinner last night. Then I ate it again for lunch today. Whoops.

... There is still splashed apple cider on my visor from January, when I somehow threw my hot cider all over my car.

... I started trying to use Google+ again. I am not sure why, but I'm doing it.

... There is a baby in this Starbucks (with his mom, of course) and I want to snuggle him. Society frowns upon just snuggling a stranger's baby though, so I won't.

... I am thinking of changing my blog name because there is nothing simple about my life. I picked Simply A because I go by "A" sometimes but... it doesn't feel right. What do you think?

Making Melissa

And, since yesterday was Blogger Men Tell All link-up for February, here are the scintillating answers from Ken for February's questions!

1. What is your favorite winter hobby?

In the winter I love checking the ten day forecast for potential snow days and then telling all my coworkers and students that I'm going to wear my snow day tie.  That way I'm not the only one that's disappointed when it doesn't actually snow.

How Ken rocks the Snow Day Tie

2. Did you do anything special for your blogger on February 14th?

We went out to dinner at our favorite Chinese restaurant, but otherwise we have a tradition of going out of our way to not make a big thing out of Valentine's Day.  Basically we woke up, told each other we didn't get anything for the other person, and then high-fived ourselves for being awesome.

3. What’s your favorite kind of candy?

Dark chocolate all the way.  Anything involving a combination of dark chocolate and coconut is even better.

4. Which Rom-Com would you choose to watch while you snuggle up with your Valentine?

Definitely not Love Actually.

Wife note: Grumble grumble grumble.

5. Who, in your opinion, is the best US president ever?

Teddy Roosevelt.Aside from agreeing with a lot of his policies (like trust-busting and environmental conservation) he just seemed like he could get anything accomplished that he set his mind to, not just as president but throughout his whole life. Plus he was from New York.

Becoming Adorrable

 So, go link up with Melissa or Becca or both! And what do you think about a name change? If you're a blogger, have you done it? How? Why? Tell me your thoughts!

Too Faced Eye Shadow Collection Giveaway

The Care and Keeping of Your Med Student

Monday, February 23, 2015

This past Saturday marked one year from the day I found out that I was accepted to medical school (again) and would be completely upending my life (and Ken's) to chase this crazy dream of becoming a physician. I couldn't have gotten here without my friends and family helping me along, but it is definitely an adjustment for everyone when someone goes from being a "real adult" with a job and mostlyfree nights and weekends to being a full time student who can tell you everything you would ever want to know (and then a lot you didn't want to know) about gastrointestinal parasites, but can no longer handle basic life skills like laundry and often finds her keys in the refrigerator.

(Hi, welcome to my life.)

So, if you're fortunate enough to love a med student (or a grad student of any kind), here is your handy guide to keeping your sanity while you help them keep theirs.

So you're married to/friends with/related to/living with/tangentially associated with a med student...

Congratulations! And our condolences. What you're about to embark upon is an adventure filled with twists, turns, tears, laughter, a lot of paper, more coffee than you can imagine, and probably some really gross pictures that you wish you hadn't seen. But it's also going to be great, because you're going to watch your loved one achieve one of their life goals! And it's also going to be terrible because you have to be involved with a person who we can probably safely assume is of above-average intelligence, but who now has lost all ability to function like a normal human being. There will also probably be crying. BUT REALLY, it is going to be great. Trust me.

How can I best prepare myself to take care of my med student?

Excellent question. Obviously, the answer varies depending on your relationship with the med student. Are you roommates? Best friends? Siblings? Legally bound to them at a federal level? Regardless, at the very least, here's a list of things to get you started:

1. Caffeine - Unless you have a rare med student on your hands, caffeine will become a new part of the food pyramid. Probably the part on the bottom that used to be occupied with grains or whatever. The preferred caffeinated beverage of the med student is coffee, but tea, Red Bull or other energy drinks, and 5 Hour Energy are all options. This med student prefers lattes, but being a med student, is too poor to drink lattes all the time, so she defaults to coffee with fancy syrup in it, or tea. This med student also is afraid of energy drinks and highly recommends that you not consume them, even though caffeine is caffeine, so it doesn't actually matter. Anyway, have caffeine on hand.

2. Paper, and lots of it - Lined paper, printer paper, legal paper, post-its, cocktail napkins -- whatever you have, make sure you don't run out. (This med student does not recommend taking notes on cocktail napkins, for the record.) You might have a med student who really likes taking notes on his or her computer, but there comes a time when you need to draw the brachial plexus 9,000 times, or you have to make a flow-chart to describe how the renin-angiotensis-aldosterone system works. For those moments, paper is the only way*.

*See #3 for alternatives.

3. White boards - Even if your med student is really into paper (like this one happens to be), he or she will require at least one white board. The bigger the better. White boards are integral for sketching biochemical pathways with various colored dry erase markers, for listing the 462 different microbes for a single exam, and for banging your head into when you realize that there are 3 more lectures to go in this block and you can't understand how you're going to fit anymore information into your brain. (Med student caretakers may also use the whiteboard as a head-banging implement for when your med student is driving you bonkers.) Savvy students and their caretakers can pick up GIANT sheets of whiteboard for around $12, and the nice people there will even cut it for you. Then your med student can plaster the walls of their room with white boards and draw to their hearts' content. 

4. Snacks - Every med student has their own preferred study snack. Whatever it is, make sure it's well-stocked, especially during exam weeks. Hell hath no fury like a hangry med student.

5. Tissues - Eventually, your med student will get sick. Or cry. Or both. 

So, food, coffee, and office supplies. I can do that.

But wait, there's more! Simply keeping your med student fed and caffeinated is one thing, but the moral and emotional support part of the job is another beast entirely. Your med student is about to get on a roller coaster of emotions that lasts 4 years, but pretend that the loops and spirals and gut-dropping hills are actually class exams, practicals, rotations, and board exams. (Trust me, you'd rather have the loop-de-loops.) Your formerly bright-eyed and bushy-tailed loved one can go from excited to depressed, confident to a quivering pile of goo, focused to more chaotic than a toddler hyped up on birthday cake, and passionate to contemplating alternate life plans like herding goats in Greece... all in the span of an afternoon! You may contemplate putting your loved one on a mood stabilizer, or at the very least, slipping a Benadryl into their next cup of coffee, but this is all perfectly normal. Your med student will return to whatever their baseline crazy was, because let's face it, none of these people are normal, and life will resume. In the interim, here are some tips for being that emotional rock that your med student truly needs (even if they don't know it).

1. Remind your med student that this is something they wanted to do. They may not want to hear it, because at some points, literally anything sounds more appealing than going through those anatomy slides, but somewhere, deep inside, is that little pre-med still doing a happy dance that started the day your med student got their acceptance letter in the mail. Find the tiny pre-med and hold onto it! (That sounds kind of creepy. Whatever, you know what I mean.)

2. Make your med student take breaks. He or she may hunker down for hours at a time, not moving, barely breathing, often making you wonder if they've gone into some kind of trance or perhaps fallen asleep while sitting up. After making sure that your med student is, in fact, awake, gently recommend that your med student take a break. Maybe drink some water instead of a 14th cup of coffee. Have a snack. Go outdoors for 15 minutes! There is life beyond the library/Starbucks/desk in the office. 

3. Don't ask questions to which you don't want the real answers. For example, "When will you be finished studying?" or "Why do you have to study so much?" never have good answers. Sample answers may include:

"Never, because I am so far behind I want to cry."
"When I am dead. Which may be soon."
"NOW, because I am giving up and going to herd goats in Greece."


"Because I am a masochist."
"Because I am so far behind that i want to cry."
"Because I am a moron. How did I even get into medical school? WHAT AM I DOING WITH MY LIFE!? I'm going to go herd goats in Greece." (This one usually leads into some kind of existential meltdown.)

Better questions to ask are ones like, "When's the last time you took a break?" (see #2) or "Can I get you a snack?" But seriously, we know that you miss the old life we used to have, where we could binge watch Netflix and go out on Saturdays and have conversations that didn't start with, "Last week, in the cadaver lab..." There are approximately 400 things that we'd rather be doing that studying, and when you ask when we'll be done or why we have to study so much, it breaks our hearts just a little bit. We'll come back to you eventually. We promise.

4. Find out the "Love Language" of your med student. This sounds corny, but hear me out. The 5 Love Languages is a book by Gary Chapman that he wrote after observing that there were different kinds of love that were given and received between clients he saw in his therapy practice. It's geared towards couples, but since love is love, it works with parent-child relationships, friendships, and people who are single. If you know your med student's primary love language, you can help support them in the best way you can. (Also, it's fun to take the quiz and see what your own love language is!)

Okay. So, anything else?

Of course. Here are a few general tidbits that you can definitely use to help take care of your med student.

1. Be understanding. This seems obvious, but make sure your med student knows that you "get it" when they have to cancel plans or when they can't seem to talk about anything but school. Even if you don't really "get it," your med student really needs to hear that you aren't going to disown them, even if they're now the most boring person on the face of the planet (and they probably need a shower).

2. Realize that you probably don't understand. I know, numbers 1 and 2 seem to contradict each other. Sometimes that happens. Life is not simple. Anyway, if you've never been to med school, there is really no way to describe what it is like to be a med student in a way that makes sense. There are analogies that kind of work. "It's like having finals week, every week," or the more traditional, "It's like drinking from a fire hose," are often cited. But really, until you've lived it, you will not truly understand what it's like to be in the trenches of medical school. That's okay, though! Your med student doesn't expect you to understand. In fact, your med student needs to you tether him or her to reality outside of med school. You are an important part of this equation!

3. Be watchful. This is a more serious tidbit, but it is very important. You know your med student probably better than most people. Med school is extremely stressful, both physically and mentally. It is very easy for your med student to become sleep-deprived and ill, or to become anxious or depressed. If you think your med student requires medical attention, make sure you let them know that you are worried. If you think that your med student is going to hurt him or herself, or someone else, you can absolutely inform someone else like the school or their parents or spouse. This isn't meant to scare you, but sometimes it is hard to ask for help. Your med student will thank you, I promise.

4. Help your med student remember that they are more than a med student. This one is very important. Your med student probably feels like their entire life can be distilled down to every exam they take. They may forget that their hard work and their grades are not the reasons that you like to be around them. Remind your med student that there is more to life than med school, and that no, their only friend is not their cadaver. Continue to talk about the things that you enjoy doing together, and help your med student to remember that someday, they will not be in med school and they might have some semblance of a normal life. (Do not, under any circumstances, say anything about how stressful and awful residency might be. And fellowship? Forget it.) Focus on the positives. 

This sounds hard. 

I won't lie to you, it is. But your med student will appreciate it more than you know, even if they don't tell you and sometimes you feel like being friends with your med student's cadaver might be for emotionally fulfilling. The good news is that your med student will totally be able to tell you if you're dying and might be able to treat your back pain with OMM if you're lucky enough to be friends with a DO. You also get to watch as your loved one achieves their lifelong goal of becoming a physician, and to know that you were a part of that is pretty special. Loving a med student is difficult, but it is incredibly rewarding. I promise.


To my husband, friends, and family, I could not have gotten to this point without you. Thank you for feeding me, doing my laundry, making me sleep, making me laugh, drinking wine with me, crying with me, and holding me up. Thank you for the hugs, the phone calls, and the encouraging texts and emails. Thank you for doing all of these things that I wrote about and more. Thank you for being you. When I graduate in 2018, you all get honorary DO's, in my book. (For now, let's not think about how far away 2018 feels.) 

I love you all.

- A

PS: Don't forget to enter this giveaway that Kate is running all week!!

Too Faced Eye Shadow Collection Giveaway

Elizabeth & Luke - Something Saturdays
Alison - Simply A

For this month's giveaway, we're doing something a little bit difference: the winner will get to choose which eye shadow collection from Too Faced they receive! The choices are: Natural Eye, Cat Eyes, Boudoir Eyes, Country Nashville, and Rock n Roll.


- The giveaway goes from 2/23/15 12:01 AM - 3/1/14 11:59 PM.
- You must be in the USA to win.
- You must be over 18 to win.
- I always choose the winner through Rafflecopter within 48 hours. Sometimes I forget to announce the winner on the widget, but I always email the winner, so if you don't receive an email, you can assume that you did not win. (I will/do, of course, try to remember to announce the winner, I promise!)
- The winner must respond to that email within 48 hours. If they do not do that, I choose another winner, and they also have only 48 hours,

The Five Most Important Things I've Heard Recently

Friday, February 20, 2015

It's Friday and I am not entirely sure how we got here. I have a lot of things swirling around in my head for potential posts and updates, but today, the only thing I can manage is to sit here on this couch, finish a bunch of laundry, and write this. And so I present to you, five things said by physicians in the last 4 weeks that have kept me going.

To say that I have had a mixed bag of experiences with the medical profession would be quite the understatement. In fact, I could probably say that more of my encounters with physicians have been less than stellar. Sometimes that has been because my doctors didn't have time, or didn't want to take the time, to really listen. Sometimes, it's because my symptoms didn't fit into any neat little box that they could check on an insurance coding form. But once in awhile, I've been fortunate enough to find a caring, empathic, innovative physician who has made me feel like more than a file full of paper. Even though one of the doctors I've dealt with was a total jerk, I've been pleasantly surprised by most of the encounters I've had since.

1 | "You have been through so much, and I am sorry this is still happening."

That was Dr. C, one of the reproductive endocrinology fellows that works with Dr. S. I walked into the office last Thursday without an appointment and not only did the nurse come out to speak with me about what was going on, Dr. C squeezed me into her schedule to do an ultrasound. I had never met her in person, but after introducing herself when she came into the exam room, she put her hand on my shoulder and this was the first thing that she said. It meant so  much to hear that from her, and to feel like I was going to be well-cared for.

2 | "This did not happen because of something you did or didn't do. It is awful and it sucks and everytime it happens to one of my patients, it hurts. I know it doesn't feel like it, but you will be okay, and you will get pregnant again."

This was Dr. T, my OB. We've spoken a few times since I miscarried and every time, she has been kind and understanding, and she makes me laugh. Humor is tough, because you never want to make it feel like you're trivializing someone's pain, but Dr. T makes me smile every time we talk. I really appreciated that even though she sees this happen really frequently in her line of work, she acknowledged how awful it was. I feel like I can connect with her as a patient, and a woman, and I really trust her to take care of me. People have asked if I want to change doctors for the next time I get pregnant, but I can't imagine having someone who isn't Dr. T being the physician I trust with my care, especially after this.

3 | "There is no need for you to feel the depth of this pain that you're feeling."

This was Dr. G, my psychiatrist. After the miscarriage, I was really not doing well. I wasn't sleeping well at night, I was waking up crying, and I was hiding in bed all day. I wasn't eating. I felt like I would never feel okay again. When she recommended that I take Klonopin to help me sleep, I resisted because I felt like I would be covering up the feelings that I needed to be working through. She laughed and said, "Klonopin is good, but it's not that good." I took the Klonopin for a few days, slept, and suddenly, life didn't seem like the alternative was a better option. She also made room in her schedule for me so I could be seen weeks ahead of my original appointment. I have had a lot of psychiatrists, but none with whom I felt I could also do therapy. 

4 | "This is going to be different for your husband than it is for you, and that is okay."

Interestingly, this was from my rheumatologist, who had nothing to do with my obstetrical care at all. He called to check on me after I sent him a message to let him know what had happened. That, in and of itself, was such a big deal to me, since he was basically just calling to make sure I was mentally okay and to tell me that from an autoimmune standpoint, there was some bloodwork that could be done if I wanted it. He shared with me that his wife had miscarried, and I said that now he had two beautiful children. He replied, "And you'll have beautiful children, too." He also talked about how miscarriage is different for men and women, and I really appreciated that because it validated a little of how I had been feeling. 

5 | "We will get through this together."

This was Dr. S, after I saw him on Wednesday for a follow-up. He is one of the kindest, gentlest doctors I have ever had, and he talks to me like I am part of my care team. When he came into the exam room, he looked genuinely upset that I was still having issues. I feel like he is so invested in my health and care, and I am just one of his many patients. It's really encouraging when I feel like my doctor really wants to be a team, and it's not just talk. When he said that, and shook my hand, I really felt like someday, things will really be okay.

And so, I soldier on. The one thing I keep reminding myself is that someday, I will have a patient who has lost their child, and maybe I can use this experience to be like these physicians that have helped me through my grief. 

Stay warm out there this weekend, and see you all on Monday!

- A

Confessions, Ahoy!

Wednesday, February 18, 2015

Making Melissa

Hello, all of you beautiful people. Your hair looks great today and I love that shirt. Sorry, I just figured everyone could use a compliment today, especially given how absolutely craptastic 2015 has been thus far. Anyway, since it's Wednesday, it's time to invite Mr. Channing Tatum back to the blog for Humpday Confessions!

I confess...

... I'm sitting here blogging while Ken makes dinner. He doesn't appear to need help, but I haven't even offered.

... I call Ken "the fuzzband" when he doesn't shave for a couple of days. I also shriek in mock-horror when he tries to kiss me or put his stubbly face near me.

... I should be studying right now, but I'm not. I have the rest of the night and all day tomorrow and Thursday. Whatever.

... I am still dealing with physical and emotional crap from this miscarriage and it's pissing me off and I hate it.

... I am really bad at folding that last load of laundry. All of the laundry gets done, and then the last load sits in a basket at the foot of our bed. Sometimes, it gets so wrinkly and full of cat hair that we have to wash it again. #adulting

... I was irrationally upset this morning when Rowan only had a delayed opening today instead of canceling class. It screwed up the entire schedule of our practical exams, which messed up my entire day.

... I also did a not-so-secret happy dance of joy when I realized that my community health assignment location was closed due to the snow.

... Last night, I dug into the first pint of Jeni's Ice Cream that my friend sent me. It's safe to say that I'm now obsessed.

I think this must be what they serve in heaven.
... I got really excited when Chris Rock mentioned Drexel University in his monologue during the 40th anniversary episode of SNL.

Post by The Triangle

... I am ashamed to say that I really enjoyed the Miley Cyrus performance of "Fifty Ways to Leave Your Lover," on the SNL 40th anniversary episode. She looked kind of amazing, especially her sparkly shoes, and I want to know which mascara she was wearing, so... you do you, Miley.  (Although I will always have an unholy love of Paul Simon and still would have preferred to hear him perform his own song.)

And on that note, I'm going to go grab that pint of dark chocolate ice cream and get back to my studying cave. Don't forget to link up your own confession posts with Melissa!

- A

Dear 2015

Monday, February 16, 2015

Dear 2015,

Hi. I know it's early to be writing you a letter, a mere 44 days after you've begun, but we need to have a chat. I'm going to be blunt; you've kind of sucked so far. I don't know who gave you your job description, but I am 99% sure that whatever was in it, all the crap that has befallen me, my family, and my friends was not in there. I mean, 2014 wasn't super awesome for a lot of people either, but that doesn't mean that we can set the bar as low as you seem to have set it. I'm trying to be brave over here, but you're making it really difficult.

At the beginning of the year, we're supposed to be hopeful. There's a whole year, spread in front of us, to be filled with good memories and hard work and fun, and even if there are bad times (which there always will be), the thought that we'll be able to get through them should be at the forefront of our minds. Instead, you decided right away to hit us where it hurt. We weren't feeling especially strong to start out, and yet you took us down a peg anyway. Rude.

In the 44 days since you've began, we have had great loss and a lot of grief, and we are not alone. You have truly run the gamut of "shitty things":

A friend's dog died, unexpectedly, and she couldn't be there with him in his last moments.

A friend and her fiance signed contracts on a house, only to have it fall through after the inspection. 

There was emotional upset at family members, and angst. Lots of angst.

There has been illness, injury, and a lot of lost time and energy.

We had 3 weeks of fraught ultrasounds and medical appointments, only to lose our first baby.

Since then, I've been dealing with the miscarriage that simply seems never-ending.

A friend's house had a huge leak and basically trashed the basement.

There has been anxiety and depression that often felt bottomless.

A friend lost one of her twins in utero at 22 weeks, then had her water break at 27 weeks and is on bedrest for the duration of her pregnancy.

A close friend lost her father to malignant melanoma.

I would give you an A for creativity and effort if I didn't want to set you on fire. 

I can only figure that your plan is to get all of the shitty nonsense out of the way, so that the rest of 2015 will be awesome, or at the very least, tolerable. However, I must say that this is really a terrible plan and that I do not agree with it at all.

So please, 2015, take a hint from the Chinese New Year, which is February 19th. Let's start over. I'm sure that we can still be friends, but please... go a little easier on all of us. 

Let 2015 be a year of healthy pregnanices and healthy babies. A year of healthy pets and family members. A year where houses don't flood, catch on fire, or fall down. A year where wedding planning goes smoothly for people, and house-buying is as easy as possible. A year where the grief is minimal and the joy is multiplied. A year where people get hired and stay hired. A year where money doesn't occupy our every waking thought. A year where chronic illness doesn't ruin plans and hopes. A year where we can control our anxiety and alleviate pain and suffering around us, not only in our lives, but in the lives of others. I'm not asking for the perfect year, because I know that isn't possible. What I'm asking for is to give us a break. Let us regain our strength, to get our feet under us, and to move forward. Let's make 2015 less sisyphean. We can work together and make it happen, I swear.

We deserve it, after these last 44 days. I'm sure there are a lot of us, far beyond my circle of friends and family, who would appreciate a little levity. We'll thank you for it, I promise.


PS: If you can make spring come a few weeks early, without like, ruining the planet and all, that would be great. 

'Fess Up

Wednesday, February 11, 2015

Making Melissa

It's Wednesday! Whoo! Honestly, now that I'm basically in a studying cave, I have no concept of time or day. It doesn't help that I'm staying up late and sleeping in and generally not going to campus unless I have to. But anyway, it's apparently Wednesday and that means it's time for confessions with Melissa! Here we go.

I confess...

... this is going to be a very short post because I am woefully behind in studying for my GI block exam. In fact, I'm currently in the middle of a recorded lecture about intestinal parasites. Basically, all worms, all the time. It's pretty gross, not going to lie.

... I'm listening to this lecture (on my headphones!) in a Starbucks, so I really hope that no one looks at my screen because someone might vomit, or at the very least, think that I am a huge weirdo.

... Ken and I watched the entire season of Masterchef Junior in about a week. I seriously wanted to pick up the tiny 8 year old contestant and take her home with me. (I did not.)

... I finally got all of the gross salt washed off of my car today, so if it snows, you can totally blame it on me.

... I hate throwing out leftovers in the fridge that have gone bad, so I make Ken do it most of the time. (Thanks, honey!)

... I am vehemently anti-50 Shades. I'd rather watch this lecture on parasitic worms on a big screen TV than go see that movie or read the books.

... I would probably eat Pizza Hut personal pan pizzas multiple times per week if no one would judge me and it wouldn't make me weigh 500 lbs. (Yes, I'm aware that that barely qualifies as pizza. I can't help myself.)

... I was too lazy to drive back to my house this morning to get my earbuds, so I stopped at my mom's house (on the way to this Starbucks) and borrowed a pair of hers.

... I want to high-five the mom that just told her daughter (who was complaining that her hot chocolate was "so small") that she didn't need a big one because it was 4:30, even if she thought she needed a big one, and that's why she's the mom and the little girl isn't. Then she tousled her daughter's hair lovingly, and everything seemeed good. You go, Starbucks mom.

... I am SO excited to see Sarah and Marcie in 37 and 40 days, respectively. I don't even care that I'm spending my spring break in the midwest when most people are going to the beach. #partyinthemidwest

... Ken and I just booked our summer vacation and it was a great experience to work with Casey from The Road Less Traveled! We'll be heading to Punta Cana for a week and I cannot wait to just lay on the beach and have someone bring me beverages with umbrellas in them. 136 days!

... I really fucking hate anatomy and the cadaver lab. I would pretty much pay any amount of money to  have someone else take this course for me.

... I keep a small bottle of Febreze in my car so after anatomy lab, I can spray myself and my car. I refuse to let my car smell like Trudy (our cadaver).

And on that note, I must return to the land of intestinal worms. Med school is great, right? If you have confessions, go link-up at Melissa's blog and let me know where to read yours!

Moving Beyond the "Shoulds"

Tuesday, February 10, 2015

I spend a lot of time reflecting on the past, and by reflecting, I mean obsessing. The only thing I probably spend more time thinking about is the future. And again, by "thinking about the future," I mean "having a lot of anxiety and obsessively worrying about the future." 

As you can imagine, with the recent events that have been going on, a lot of both of these things have been occuring. Usually, the future obsessing is what gets me into trouble, but this time, it's getting stuck in the past and what "should have been." A woman that reached out to me after my miscarriage, Steph, has been absolutely wonderful and supportive. Before this, I was only vaguely aware of her existence, mainly in the context of her younger sister, with whom I went through school. However, when she messaged me after reading my blog, I found a lot of comfort in talking with her. Life sometimes brings you exactly who you need. One of the (many helpful) things she has told me is, "The sooner you get away from what should have been, the easier you might find it." She's absolutely right, but it is so difficult.

The first time I experienced this in real time was last week on Monday, when I saw my OB for a follow-up appointment. Fortunately, she had been able to fit me into her schedule. Unfortunately, it was on the same day at the same time that I was already scheduled to be seeing a different OB in the practice for my 10 week prenatal appointment. I was in the same office I would have been in under completely different circumstances, and I couldn't get away from that fact. The entire time, I was trying to keep it together in front of my doctor, but underneath, I just wanted to collapse onto the floor and cry at the unfairness of it all.

Also, every week that passes, I have a brief moment (or 27) where I think, "Oh, I would have been ____ weeks this week," which obviously isn't great for my mental health. I did a pretty good job of immediately unsubscribing from all of the pregnancy-related emails I had been getting, but every once in awhile, some associated email will come through and I'll be right back in the mire of the grief. I know that eventually, this will stop. Honestly, it's already gotten much better in the past 3 weeks. I've been able to enjoy going out with friends, I'm sleeping better (thank you, Klonopin, meditation, and, I am eating, and I'm not crying every day. Don't get me wrong, there are plenty of days where I can barely get out of bed, and the other night, I woke up at 1 am and burst into tears. One day at a time.

The "shoulds" have haunted me before, as well. When I left med school in 2009, I was mostly concerned with not killing myself and getting out of Florida. After I got over the initial trauma of what happened though, I had a lot of "should" moments. 

I should be finishing first year.

I should be starting rotations now.

I should be finding out where I matched for residency.

I should be walking in graduation.

As expected, now that I'm back in school and all of those things will be a reality for me in the not-too-distant-future, the shoulds of Med School 1.0 have largely faded into the background. They're definitely still there though, and they come back often when I talk to a friend with whom I would have graduated. I am thrilled beyond words for my friends who are doctors, who are kicking ass in residency, applying for fellowship, interviewing for jobs, and being made chief residents. I am also incredibly sad that I am not doing it along with them.

So why do we get "the shoulds"? I don't have all the answers. I wish I did. But I think for me, I get them because I don't allow myself the grace and forgiveness I give to others. I hold a lot of anger and resentment towards myself for what I could have done differently (like with med school), or even if there was nothing I could have done (like with the miscarriage). Living with that anger doesn't allow me to ever move on, and while it took me 6 years just to start forgiving myself for med school, I really hope it doesn't take that long for me to heal from this miscarriage. I don't think it will, largely because I do know that it wasn't my fault, whereas med school maybe could have been prevented if I had done things differently. (I'll never know and I can't even entertain that line of thought because if I do, I'll never leave it.) 

What can I do about this, though? A lot of it is just waiting, and time. Since I'm terrible at waiting and not being in control, this is one of my worst nightmares. What I can do though is be kind to myself. I can do more self-care. I can let my friends and family hold me up. I can write and talk about it. I can try to refocus my thoughts on the future, or better yet, the present. 

Like I said, I don't have all the answers. If you get a case of "the shoulds," what do you do? For now, I'm going to continue breathing, going to acupuncture, studying, and of course, when all else fails, there's wine and chocolate. I am a blogger, after all.

- A

An Ode to My (Probably Overreactive) Rage

Wednesday, February 4, 2015

I'm currently sitting in my preferred corner of the sofa, drinking a steaming cup of hibiscus tea. There's a kitten playing with a balled up receipt (which he has decided is the BEST TOY EVER, at least for the next 5 minutes) and a giant orange cat curled up behind my head, softly snoring. It's quiet, except for the sounds of my handsome husband making dinner (he's kind of the best). I should have nothing about which to be angry and yet... I am cranky.

I am cranky because there are people at my school, a school of OSTEOPATHIC MEDICINE, who think that osteopathic medicine is a bunch of crap and loudly declare their opinions to anyone within earshot. If you didn't want to be a DO, then you shouldn't have come here. End of story. You're sitting in someone's spot who, at the very least, wouldn't spend their entire existence wishing they were at an MD school. You make the rest of us, who on some level really like osteopathic medicine, or at least are grateful to be here, feel like punching you in the face. Get off my lawn. Go home.

I am cranky because there are a ton of people in the world not vaccinating themselves or their children. I am all for doing whatever you want, so long as it doesn't harm anyone else, but I am 100% sure that not getting immunized against completely preventable diseases (excluding the flu, but still, go get a flu shot) is fucking harmful. And for all of those people who say that their kids are fine and they're fine, well that's fucking great, but guess who isn't fine? The infants who can't get vaccinated until their older, the immunocompromised people (like myself) who, even if they do get immunized (which I do, thank you very much) still get sick a lot more often than we should (yay autoimmune disease!), pregnant women who can't receive certain vaccines, and anyone who is currently getting treated for cancer with chemotherapy, because clearly, having cancer isn't bad enough, they have to worry about getting fucking measles now. You aren't getting immunized for YOU, you're getting immunized for the good of society and herd immunity. Here's the thing about herd immunity... enough people need to be immunized for it not to break down (LIKE IT HAS). For example, you want herd immunity to protect the infants and the chemo patients from getting measles? Then you need 83-94% of the population immunized to accomplish that. From one person infected with measles, you will see anywhere between 12-18 new cases. That is not okay!! Like charts? Here's a chart.

If oyu like academic papers, read this: Epidemiology Reviews, 1993
Also seen on Wikipedia, as well as this NOVA website and this CDC presentation
For you non-epidemiology folks, R0 is the basic reproduction rate and is used ot measure the transmission potential of a disease. For influenza, the threshold ranges, but generally is assumed to be between 80 and 90% for herd immunity to be effective. In the US, we are nowhere near that. So yes, even though our flu vaccine this year was only about 23% efficacious, that is still better than 0%, and again, you're not getting vaccinated for you; you're getting vaccinated for all of those people who can't get the vaccine themselves. But alas, no matter what you tell these people who think that's it's totally cool to not vaccinate themeselves or their kids, they won't change their minds and the rest of us have to refrain from commiting a felony when we read some ridiculous quote from an anti-vaxxer parent (or worse, this doctor, whose interview I cannot even listen to because it turns my stomach).

I am cranky because I disagree with the clinical guidelines on miscarriage and testing. Because 25-40% of pregnancies end in miscarriage, it is decidedly a "common" event and so medically, practitionres don't start doing any kind of testing for possible causes until a woman has had THREE miscarriages. THREE. I cannot imagine doing this three times. Once was bad enough. If I have to do this three times, I may just find a bridge and jump off of it, because I cannot take it. Fortunately (?), I have a reproductive endocrinologist who is gung-ho about testing and me being pregnant. He called and ordered a lupus anticoagulant panel, because there are certain antibodies that can increase the risk of recurrent miscarriage and he wants to know if I have them because guess what? You can treat that in a relatively easy manner (most of the time). Even if I have the antibodies and they didn't cause this miscarriage, it's important to know that I have them for future pregnancies. I'd also like to make sure that I get plenty of progesterone monitoring done before and after I get pregnant next time, because there's sometimes a problem where your body doesn't produce enough progesterone to support a pregnancy. Guess what? That's easily fixable too.

It makes me so angry that there are women out there who have lost babies due to something called an incompetant cervix, which means that a woman's cervix opens way too early and if not fixed, the pregnancy will be lost, often in the second trimester (when miscarriage risks are supposed to go way down.) You know how that gets fixed? Monitoring and putting in a cerclage (sutures to reinforce the cervix that are then removed around weeks 36-38). Even if a cerclage isn't put in, so many women aren't even being screened for this potential defect. Why? I have no idea. Probably lack of resources or clinical data showing that it's rare, so we shouldn't do it. To that I say, try telling a woman who's lost a baby at 20+ weeks that and see what she says. You can bet I'll be pushing for monitoring to the utmost degree when I get pregnant again. In fact, when we meet with my reproductive endocrinologist again (Dr. S), I am going to talk to him about Clomid, a drug that induces ovulation. Now, my body seems to ovulate just fine (thank the good Lord I don't have that issue), and I was able to get pregnant without any interventions last time. However, having PCOS can make the quality of your eggs go down, and Clomid can help improve that. Of course, no one MENTIONED this to me, so I didn't know. There also seems to be clear-cut guidelines on whether Metformin (a diabetes medication used to treat PCOS) should be continued through the first trimester to decrease risk of miscarriage. The doctor who treats my PCOS said yes, the maternal-fetal medicine doctors and my OB said no. I stopped taking it. Maybe I won't do that next time. Who knows? What I do know is that no woman should have to lose three babies before someone decides its a problem. It's almost like medicine gives you one "free pass," like your first baby is a practice-run, and if you get a live, healthy infant at the end of it, then you win! If not, better luck next time. (And yes, one of the doctors in the practice actually said to me, "Better luck next time," and I wanted to throw something.) Unacceptable.

I'm cranky because my body still hurts, and my heart hurts more. I am taking medication to sleep, and it makes me drowsy during the day. I get really emotional and heartsick when I see pregnant bellies, even though I know that makes no sense. I picked out a baptism card for Sarah's baby today and had to evacuate the card aisle at Target before I had a meltdown standing next to the baby shower cards. I'm tired of feeling like I will never feel okay, and I'm tired of waiting for my body to get its proverbial excrement together so I can move on and start over. Right now, I am living in limbo, where my body hasn't quite figured out what is going on, and it sucks.

 I am cranky because it is cold and I hate it. And yes, I know that I live in the northeast and it's winter, but the air hurts my face and it hurts to breathe and it makes my joints hurt and going outside is painful. The salt on the road makes my car continuously look disgusting, and I never want to go outdoors. I should have been a hibernating mammal.

I am cranky because I am behind on schoolwork and I didn't do as well on my renal and respiratory exams as I wanted to. Given the situation in my life, I should be grateful that I passed the ones that I did and that the one that I failed won't permanently screw me in the long run, but I know that any other week, I would have been FINE. I would have bitched and moaned, but I would have at least passed them all, and probably high-passed one or two. I can't seem to get into this block either, because everything seems useless and stupid in the face of what I'm dealing with, but I suppose at some point, I will have to put on my big-girl pants and get a move on. T-13 days to OMM exams and T-17 days until our GI exam. Time's a-wasting.

I am cranky because I have yet to call a contractor/handy-man to install our foyer lamp, or hook up the ice machine, or any of the other 938 tiny things that need to be addressed in this house. Our third bedroom is still a disaster, the office remains mostly unfinished. There is 1 piece of art on our walls. These are all extremely minor things, but they are grating on my nerves.

I am cranky because most of these things that are making me cranky are stupid things, and I should just get over it, but I can't because I am not in my best mental state and I just want to hide in bed until life works itself out. Cool? Cool.

And on that note, I'm going to go and actually study. But I won't like it.

TL;DR - If you didn't want to go to DO school, get out and get off my lawn, vaccinate your damn kids and yourselves, miscarriage is awful and I want all the testing even if I've "only had one", med school and winter make me angsty.

- A

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