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Posts Tagged ‘medical school’

Sometimes the stats for my blog make me sad. No, not because I have so few visitors, I expect that. I am saddened by the ways people are brought to my blog.

What do you think is the most common search phrase that brings people to my blog?

“Why am I such a screw up?”

That never fails to surprise me. And make me sad that there are people out there hunting for the answers to this on the internet.

But it’s only the top in terms of precise search terms. The top category is a combination of eating disorder plus some term related to medical/grad school (MCAT, medical school, medical school interview, grad school). I’ve googled these before. It’s nearly impossible to find any answers. Eating disorders in medical school (and to a lesser extent, grad school) are not talked about. They are not written about. They are hardly mentioned at all. Which also makes me sad. It also makes me think that I should write more about that and how having an eating disorder does fit (or not) into medical school. My struggles, the decisions, my successes. Making this less personal (I know 99% of the people reading this probably know me) and more helpful for others like me who feel alone in this struggle.

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Still a student…although not the type I want to be right now.  I didn’t get into medical school off the waitlist. In fact, I never moved from 5. Instead I’m still an MPH student because I managed to screw up my graduation.

In my last post I was given relatively few options. Four days after that I was at student health for an follow-up appointment for my IUD. I hadn’t been there for an appointment in a long time and my weight was significantly down. The nurse (who sees me much too frequently) noticed the weight and mentioned it to the doctor. Who freaked out and, because my regular eating disorder doctor was out of town, took bloodwork and contacted my doctor the next day. I went to see my doctor the next day (Tuesday) who told me I needed treatment. Then on Wednesday I went to see E and she told me that I would be going inpatient–no questions, no excuses, no delays. I cried all evening and spent all of Thursday trying to figure out how to get out of it. Unfortunately, the only treatment program my insurance would cover is at the hospital I work at. Friday I took a genetics exam in the morning and was admitted on the inpatient unit that afternoon.

On the unit with people I work with. My resident doctor had worked with me when she rotated through my unit. My nurses had floated through my unit. The aides either floated through my unit or went to “violent patient” incidents with me when called. I had taken care of several other patients. This hospital has a very strict eating disorder program. My days were nearly all the same and went something like this:

6:30 a.m.–get woken up for daily weights

7:30 a.m.–breakfast in the dining room

9 a.m.–activity

10:30 a.m.–psych ed group with a nurse

11:30 a.m.–lunch

1:30 p.m.–activity

2:45 p.m.–afternoon snack

3 p.m.–group with a therapist

5:30 p.m.–supper

8 p.m.–evening snack

10 p.m.–bedtime

As part of the eating disorder protocol we are required to be supervised continually from 7:30 a.m. to 10 p.m. This means when we aren’t at activity or in groups we have to stay in the dayroom with a staff member dedicated solely to watching us (up to 8 patients, although no more than 5 when I was there). We are not allowed to go to the bathroom on our own. We have to show the toilet to a staff member before flushing. We are “redirected” for standing, walking, crossing our legs, or jiggling our feet. We are not to discuss food, calories, weight, exercise, or other potentially triggering topics. Because it is a general psychiatry unit with non-eating disorder patients we cannot have anything with metal and our makeup/personal care items must be checked out from the nurse’s station. We cannot have cell phones or laptops.

26 days and too many pounds later, I discharged to the partial program. Where I’ve been for the past 4 weeks. Gaining more weight. Weight that makes me sick at the sight of my own body. Weight I can feel every night when I walk my dog.

But I’m done with the partial next Friday. Done whether I’m at target or not (and I am fervently hoping that I will not be there yet). I haven’t set up any follow-up therapy appointments. I’m hoping that no one will notice and I can go through the rest of my life without people bothering me about my weight and wielding the threat of inpatient or partial over my head.

The only requirements I have to finish for my MPH degree are 60 hours of work on my practicum, a paper on what I did, and a poster presentation. The work will in less than 3 weeks. The paper and presentation can’t be done until December, unfortunately so I cannot get my diploma until then.

However, student health has offered me a part-time (20 hours/week) position to do one-on-one counseling with students who are at risk for problems with alcohol. I will begin that the week after I finish partial and continue working my 20 hour weekend job at the hospital.

And because I didn’t get into medical school I have to begin forcing myself through that laborious process yet again and now I am also considering PhD programs in clinical psychology.

I don’t know how many more rejections I can take.

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I’ve been in partial 3 weeks now. It hasn’t been terrible. I wanted to run the first week, but that urge has weakened since then. I finally started restoring weight (it was slow to come) and that has freaked me out. It’s not necessarily the number that scares me; it’ the direction. When I saw the same number on the way down it was great. Seeing it on the way up is terrifying. I’m afraid it won’t stop. I’ve also begun getting the “night sweats” that come with restoration. Not particularly pleasant.

I am uncomfortably full. I feel my body changing and as a result of both of those I feel horribly fat.

And apparently in the past year I developed a lactose intolerance. They give me so much milk at partial. The first two weeks were hell with bloating, and gas, and nausea until I figured out what was going on. I don’t touch milk at home because I don’t particularly like it. I used to have a latte every single day. In the past few months they have increasingly made me nauseated. I thought at the time that it was simply the restriction making my stomach more sensitive to strong foods like coffee (which does happen) and I naturally cut back on them. Looking back now, though, I wonder if it wasn’t the lactose that bothered me. Regardless, I use Lactaid at partial and avoid milk at home. Thankfully, yogurt doesn’t seem to bother me. I think I would die without my Chobani.

On the medical school front: I am currently on the in-state waiting list for my University’s medical school. I am low on the list, #46. It’s been a rough week (really two weeks since my letter got lost in the mail and after waiting a week I had to personally go in to find out). It will be more accurate in another week or so as people respond about whether or not they want to remain on the list.

Last year I told myself and everyone else that the rejection was ok, that I was glad for the extra year. But even as I said that my weight dropped. So clearly, there was some sort of disconnect within me. I found myself doing that again this year, but now I have been saying what I actually feel. I sobbed for the entire first day (I never cried once last year). I am sad. I am angry. I am pissed off at the admissions committee, the director of admissions (who told me I would have “no problem” getting in this year), at the entire medical school system, and at myself for even allowing my hopes to get up.

And you know what? Just acknowledging those emotions has made it easier.

I am moving forward for my backup plan. I have accepted the evening clerk job on my unit (can you say regular hours, no floating, no weekends, and a better salary?). I am working on cover letters for graduate assistantships. I am researching other graduate programs to apply to in addition to one final round of med school apps. And I am starting to look more into what I could do if I just used my MPH as a terminal degree.

We’ll see what comes. Time will tell, both on the weight front and the medical school front.

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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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So much has changed in my life recently! Or if it hasn’t changed yet, it has recently gained large potential for a near-future change.

1. I cut back my work hours at the hospital.

This was a really hard choice. One one hand I was spending 40 hours/week at work and only 10 hours (or less) on school. I was making it, but since the discovery that I really love grad school and love what I am doing, I want to get the most out of the experience and that wasn’t happening with all the work I was doing. My supervisor was really good about the decision and I am down to 24 hrs/week starting next week!

I tend to count my worth by how many hours of work I do in a given week (and I typically don’t count school work) so I equated cutting back work hours with being a failure at life. And there are always financial considerations–but the job really didn’t make a huge difference there. I already had to take out some student loans to cover tuition because I didn’t earn enough for that in addition to my living expenses. (yes, considering the job requires absolutely no degree, it pays decently, but I could get a better paying job that better utilizes my knowledge) Now the job will cover living expenses and that’s it.

And although I love my job, it is physically and emotionally demanding. Even with a healthy degree of separation from the patients (which happens to be one of my few talents), psychiatric work takes a toll on a person. Although I never take the beatings (verbal or physical) personally, one can only take so much abuse. After a while of cursing, and accusations, and manipulations, and altered perceptions, and hitting, and biting, it becomes rather difficult for me to bite my tongue and turn the other cheek. And yet, I have to. Plus, working with people who are also medically sick means I have to put forth quite a bit of physical effort and that is not ideal at this time either.

Basically some work=good for keeping a healthy balance with school. Too little work=an unhealthy obsession with school. Too much work=way too much stress.

2. I was invited for a medical school interview at the university I am currently attending.

Not much to say about that. It’s a good thing. It’s happening at the end of October.

3. I am in conversation with a research team about a different job.

With a psychiatric researcher with a lot of neat projects going on.

The initial offer was hourly (read: no benefits) so my initial desire was to just pick up some hours in addition to my hospital work. But it’s possible that it could be made into a graduate assistantship….which means it could include benefits and a tuition scholarship. I’m meeting with the research team Thursday. Stay tuned.

Oh, and at the end of the email she wrote “with your background and experience we would love to have you involved.” A compliment! It did make me rather happy.

In other news:

I have cut back on exercise. I am dealing with it moderately well, Zephyr is not. He is becoming neurotic. He has always had this obsession with lights (and I mean that in clinical, not colloquial terms). Every shadow or ray of sunlight prompts him into his “light hunting” stance and he stares at it intently and then dances around pouncing on it, wiggling his tail, and sometimes escalating into barking. Within the past week it has become unbearable. I can’t open a three-ring binder, turn a lamp on, read my book before bed, open the door to an unlit room, keep the blinds open at night, keep the blinds open during the day….and more. Last night I completely darkened my room, with the blackout curtains I use to sleep after night shifts, and he was still up until 3  dancing around on the bed chasing some invisible light on the wall. He awoke at 6:30 to start it again and is still at it 3 hours later. This means I got 3 1/2 hours of sleep. And I seriously want to strangle the dog…but I can’t, because I know it’s not his fault. It’s definitely gotten worse since he’s getting less exercise with me. So I have a few things to work on here. I need to wear him down somehow: whether it is running with him (despite the ban from my therapist), making frequent trips to the grassy space outside for tennis balls and frisbees, or going to the dog park. I need to get him some more mental stimulation–with all the work I’ve been doing this has fallen by the wayside and I will start scheduling training in our days. And we just need to deal with the anxiety issues more.

I am still freaking out about weight.

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My new therapist really knows how to hit a point home. We were talking about my motivation to recover. I’m not sure where it is most of the time; I do hate a lot of things about how I feel now but at the same time I am completely and utterly terrified of gaining weight. She pointed out a chair across the room and designated at the ED-free life zone.

“Are you willing to get out of the chair you’re in now and take a step toward that chair?”

Silence

“It can be something small. In fact it doesn’t have to even be a step at all; it could be scooting yourself forward to prepare to stand up.”

I might be able to do that.

“The catch is, you can’t go back to that chair when something happens or when you feel uncomfortable. Well, actually you can, but that doesn’t help. You need to keep moving forward. Let uncomfortability be your guide.”

Dunno about that one. It’s pretty easy to fall back on ED.

“In five years you could still be sitting in that ED chair. It would be no problem at all. But is that chair getting you what you want? How about medical school in that chair? I assume that medical school will be a challenge enough as it is and adding the challenge of an eating disorder could sabotage it all. Do you want to have to take a semester, or a year, off for treatment and fall behind your class? How about having to tell your staff doctor that you need to take a medical leave of absence from your favorite rotation because your weight is dangerously low?”

Damn you. I know medical school is impossible in this state. Taking time off? Why would I ever do that? But hearing it said aloud scares me to death.

I ferociously guard my history of an ED at work because I’m afraid that people will want to limit my options if they knew about it. If the behavioral health people knew I was struggling with an eating disorder would they worry about me working on the psych unit and getting pulled to work on the unit with the eating disorder program? I am very good at separating work and personal life; despite my extensive history with this hospital (my mother’s extensive hospitalizations there, my brother’s severe accident and subsequent time in the ICU, my own time in ED treatment) when I get to work my mind thinks only about work and what the patients need. My own issues never cross my mind. But people don’t know that. Talking to someone who knew about my treatment I was advised that I should tell my supervisor about my history so she could “be aware of the effect of the patients’ issues on my own recovery.” Ridiculous. I know myself better than she. I know what makes me worse and it is definitely not work.

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One of my “to-dos” for my new medical school application is to receive feedback from the schools that rejected me and find out what they saw to be weaknesses in my application. I have emailed some, I plan to call others. My new job is actually at a hospital affiliated with one of the medical schools I applied to (one of my top choices, too) and so I was conveniently able to meet in person with their admissions director. It was an interesting meeting.

She had pulled up my application and made notes on it. I’ll run down it…

Grades: Excellent GPA. Last fall I had a couple difficult classes that I didn’t do so well in because I was pretty sick with the eating disorder and couldn’t focus long enough to read an entire textbook page. In the comments I wrote “extended illness” because I didn’t feel that they really needed to know more than that. She said I didn’t need to take any post-bacc work to raise my GPA. I told her I was starting the MPH program and she thought it was great.

MCAT: Fine. Within their average accepted ranges. She said I could choose to retake it, but it wasn’t really necessary. (I had already registered to retake it, so I continued with it)

Experience: Wonderful. She appreciated that I had worked in so many medical situations (hospital, nursing home, psych and medical units). I had shadowed doctors and really seen what they did and determined that it was what I really wanted. I volunteered in both healthcare and other areas that I had interests in.

Interview: Outstanding. She said they thought I did wonderful on the “structured” portion and I really “blew them away” on the unstructured portion. Apparently, most people who graduate early struggle with the unstructured portion.

Then the written application is reviewed by a committee and given a numerical score. She estimated that I had probably missed the waitlist by 5-6 names. Great.

What I got out of the conversation was that my application was more than sufficient. However, I still didn’t get in. Frustrating, no?

It relieved me from the fear that I hadn’t done enough this year to improve my application because apparently my application is quite good. But at the same time I find myself thinking if this application was good enough this year and I didn’t get in, why the hell would I expect to get in with essentially the same application next year? I suppose I should trust myself…and the admissions professional…

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