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Archive for November, 2010

Nighttime

I have never wanted to be done with work this much. I have been here since 11 p.m. and I still have 2 more hours to go. I have been in constant motion all night.

But it’s not even that really.

Matt is visiting me for a couple days. When I work overnights and it’s just me it’s not much different from an evening shift–my house is empty for 9ish hours. But leaving home and knowing that someone else there is getting to sleep all night long. That’s hard. And it’s even harder knowing that that someone is a person I don’t get to see a lot.

But right now all I can think about is forcing my body to keep moving for a couple more hours. I feel like my legs are going to collapse and, given the chance, I could fall asleep almost anywhere.

I’ve been questioning my ability to do overnights anymore. But I have to remember…they aren’t usually this hard. And push through them. I’ll have enough in the future during residency. (although for me just the fact that I could sleep–even if I don’t get the chance to–makes me infinitely less tired….ah, irony)

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Worthless

I have a friend (not a close one) who is absolutely amazing. She spent last summer in Hollywood working as an intern for Entertainment Tonight. Two weeks ago she was on the Tonight Show with Jay Leno….for the second time! And she was just offered an internship for next summer with the Colbert Report. Plus add in that she is a very good jazz musician and is completely gorgeous.

And here I am…I didn’t get into medical school last year (still waiting to hear about this year), I have been rejected from 16 (yes, actually 16) research assistantship jobs in the past 5 months. It’s not that I want to be on the Tonight Show, but I want to do amazing things in my own field….and I can’t even get a lame research assistantship in the state of Iowa.

At the hospital all the nurses have these cards behind their ID badges that read RN in really big letters. The doctors liked them so much that now they also have cards behind their IDs that read “DOCTOR.” (Personally I think it’s kind of biased that only the MD/DOs get them…what about the PharmDs, DDSs, PsyDs, PhDs, who all work in the hospital and are also “doctors,” but I digress). Some of the nursing assistants on my floor have a running joke that we should just get cards that say “worthless” to put behind our badges…because not having a card basically means that. It sounds awful, but it’s kind of true…doctors will ask me to do things, patients ask me to do things and I have to ask them if they realize that I have absolutely no power at all to do any of that stuff. I mean, I’m not even allowed to touch the IV pumps. I do what I’m told and am very cautious about doing anything extra that might not be allowed given my lack of credentials.

And there are some of my fellow MPH students who are also applying to med school this year that have already been accepted. Granted, they interviewed earlier than me, but my thought is still “what if I’m not accepted until March? What if I’m not accepted at all?” and I jump to the conclusion that because of that I will forever be inferior.

Basically, I feel worthless in all areas of my life. Really worthless. The “why the hell am I even allowed to walk on this earth” type of worthless.

And I am fat

Which logically doesn’t even connect to this subject, but my head still puts it all together.

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Work has been even more emotionally draining recently. Think it was impossible to commit suicide on an inpatient psych unit? Think again. I’m not even sure if it would be classified as a suicide attempt or a straight out suicide. The patient attempted to [did] create a noose over a door, was found minutes later by staff who immediately called a code. Then transferred to the ICU with a broken neck and last I heard had been put on palliative care (meaning death is imminent).

I’m not sure what to think about it. I wasn’t even working that night, but it still had a profound effect on me. Now the restrictions on the unit are even tighter, we have more one-to-ones, and everyone is on edge regarding suicidal patients.

It’s scary, but the scarier part? We can only control so much….any patient who wants to commit suicide that badly will find a way. Heck, I can still come up with ways to commit suicide on our unit, and I am most definitely not suicidal.

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Anger is our wisdom’s way of telling us something needs to change.

Late Wednesday night I reached my breaking point. I got pissed off. What the hell have I been doing to myself these past few years?

I want to be strong

I want to return to running half marathons and not just finish, but improve

I want to start crossing goals off my life list, not just watch it grow longer and longer.

I want to repair my current relationships and make new ones.

I want to live my life

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This past Friday I had an interview for the med school at my current university. Apparently their interview format intimidates a lot of candidates….which makes me feel slightly guilty for saying that I utterly enjoy the day.

It started with the standards: meet the other interviewees, hear from some person in the admissions department, hear from the curriculum director, hear from a financial aid person. All these dutiful pre-med students take notes throughout the presentations. I was honestly the only one (of 15) who took absolutely no notes. Why? Everything they told us was also included in a packet of papers they gave us. And I sat through them all last year. And, since I am there every single day, it is no problem to simply stop in and ask whatever questions I have (they are very good about that sort of thing).

Then the group split: half went to interviews and half had a case-based learning session. I started with the case-base learning (CBL).

How to describe CBL? Well, it’s basically taking all the facts you would get during a “real” medical case, making a differential diagnosis, discussing your next move, and coming up with a final diagnosis. In the actual curriculum one case is spread across 5-6 weeks, while in the interview we get through most of a case in an hour. The case is split up across approximately 10 pages. Each page has a snippet of information (i.e. chief complaint, medical hx, social hx). One page is read at a time and after each page the group does the following: a) discusses the most pertinent details from that page b)creates of list of all the possible differential diagnoses c) creates of list of questions or further information they would like about the case. In actual medical school the students would do two pages or so and then break for a week with “learning topics.” An example of a learning topic would be to research possible causes of low blood calcium.

Decision: I like case-based learning.

Then…the interview. The U- does their interviews in a slightly different manner from other schools. It is a “blind interview,” meaning that the interviewers know nothing about you except your name and your undergraduate school–they haven’t seen any part of your file. The interview itself is split into two distinct sections: structured and unstructured.

Structured–This section consists of three standard questions asked of every candidate. The interviewers are instructed to not respond to your answers (apparently they have researched this and discovered that allowing them to respond often leads to follow-up questions that get off topic and prevents them from getting all the information they really need). Many people find this to be intimidating because the interviewers simply sit there and occasionally nod or take notes while you just talk. I could honestly take it or leave it. One question is always an “ethical” question with no right/wrong answer. Strangely enough it was exactly the same question I answered last year. Someone asked me (since I was rejected last year) if I changed my answer…of course not, it’s what I believe and I’m sticking with it. I will not lie about my values just to get a spot in a particular school.

Unstructured: My favorite part! It’s just a free-form talk session with the interviewers. This is when they can ask the follow-up questions, satisfy the other burning curiosities, or simply have a discussion. I love talking about medical stuff (well, actually I just love talking in general). So I think having full access to talk about medicine with two MDs is like a dream come true. Apparently this also freaks out people because there is no defined structure. Apparently most medical school candidates are freaked out over everything.

This was followed by lunch and a tour with a medical student. The tour was interesting. It was a with an M1. M1s don’t spend any time in the hospital and don’t have many (if any) classes in the actual medical education building. However, as a public health student all my classes are either in the hospital or the med education building. And working in the hospital….well, let’s just say I’ve spent a lot of time there and am getting rather proficient at navigating the 64 miles of hallways in the building. In fact, the med student asked me to comment on the health science campus and schools at times. And in the hospital…he was quite interested in the little tidbits and details I could add.

All-in-all it was a good day. And I received an email tonight that my final recommendation letter was received. So by tomorrow or Friday the U- will have it downloaded on their servers and my application will be complete and ready for review by the full admissions committee!

And it’s back to the waiting game…

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Autumn, Fall, Otoño

…l’automne, Herbst, jesen, осенью, fómhar, autunno, فصل الخريف….

Whatever you wish to call it, it’s nature’s work of art. I have determined that fall and spring are my two favorite seasons…though I’m not sure which one ultimately wins. But I appreciated this week how truly beautiful fall in I— is.

The leaves change colors. Lawns are covered in a beautiful carpet of reds and golds and browns and yellows. (Rest assured, when I have a yard, I will be one of those people who doesn’t rake) I love the earthy tones of the whole season.

And those rich colors blend perfectly with the rich scents that are so inextricably linked with fall. Pumpkin, apples, cinnamon. Speaking of pumpkin, I love all things pumpkin: pumpkin yogurt, pumpkin bread, pumpkin pudding, pumpkin muffins, pumpkin ice cream, pumpkin lattes, pumpkin cookies (oddly enough I’m not a huge fan of pumpkin pie).

I think part of what makes it so enjoyable is that it juxtaposes the best characteristics of summer and winter to create a delightful season that is so very distinct. Fall is the time I can sit in the sun and be very warm, but a cool breeze plays over my skin and makes it a perfect temperature. The best clothes of winter (scarves, sweatshirts, hats) can be worn without the bulkiness that comes with multiple layers in winter. The mornings are chilly with frost but the afternoons are nice enough to wear a t-shirt.

People are out. Running, visiting parks, raking leaves, grieving the end of summer, relishing the final warm days, and taking it all in before the bitter cold of winter arrives. The final crop is harvested from the garden, dead plants are pulled up and composted, and the soil is readied for its time of rest.

When I wake up in the morning it’s chilly enough that I adore the warm comforter on my bed, but stepping out on the bare floor is not painful.

I often feel like people are so disconnected from the earth (at least compared to my rural upbringing), but it seems that a greater number of people are closer to nature during the fall.

I do believe we have some of the best weather in I—. Spring and fall are amazing (so I might be a little biased…), summer is warm, and winter is cold, but not incredibly long. We have all four seasons, each quite distinct, and none of them dominate.

In February I will be questioning my sanity in not moving south when I had a chance. As much as I dislike the chill of winter, I wouldn’t give it up for the world because it is part of what makes fall so enjoyable. And these are the days that remind my why I love I— so very much.

And though my dread of the coming cold can sometimes affect my enjoyment of fall, I just remind myself to take each day as it is, to step on all the crunchy pieces, breathe in the earthy smells, roll in the grass with my dog, and fully appreciate it all.

~L

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