Fatigue

Before, when things got tough, my approach was to put my head down and push along. As things got harder, I kept at it. I would flog my body and my mind harder to keep up the pace.

Before medical school, I had experienced the usually fatigue. The sleepless nights of a newborn. The occasional all-nighter before a college final. The long road trip. Most of my fatigue was easily managed by a few extra hours of sleep on the weekend or going to bed a little earlier.

And then came medical school. Early classes, late evening labs, and then the studying. The 4-8 hour a day studying. My time to sleep was cut back. From 8 hours to 6 hours, and then to 4-5 hours of sleep a night. Obviously, my ability to stay awake in lecture decreased in direct correlation to my lack of sleep. So, naturally I turned to a cheap legal stimulant. Caffeine. Yes, I was a caffeine consumer before this. I enjoyed my diet Coke, I loved the occasional latte. But now, caffeine wasn't an occasional enjoyment. It was a daily essential. I started drinking Coke after Coke. Then it was coffee after coffee. Enough that Hubster accused me of keeping Starbucks in business.

I was rewarded for flogging myself harder. I got fantastic grades, top marks on exams, flew through boards with amazing scores. Because I had realized early on in medical school that, unlike in undergraduate classes where I was unquestionably the smartest person in the class, in this academic arena, I was only an average smart person. My ego and my view of myself were at risk. I could never out-compete my fellow medical students on sheer brains. I would have to out-compete them with effort. So I studied, beat my body with lack of sleep, beat my brain with caffeine, and succeeded.

And then things got worse. Monkey was born (okay, that's not the "worse" part, that was the joyous part, but still, newborns are hard). I started clinical rotations and started taking overnight call every fourth night. I started working 80-120 hours a week. And still studying. I cut my sleep from 4-5 hours to 3-4 hours. I went every fourth night without sleep. I was a zombie. Coffee, no matter how strong, wasn't cutting it. So I turned to caffeine tablets. 200 mg of caffeine a tab. Multiple tablets a day. So much caffeine in my system that I had horrific withdrawals.

This is where the story could become tragic. I've seen it happen before. I've watched it happen. But I had made Hubster a promise that I would never take anything illegal. That I would never use something that wasn't available at Wal-mart.

This is where I also grew up.

Residency is similar in its demands on my time. There are still plenty of sleepless nights.

But as part of growing up, I'm gentler with myself. Instead of whipping myself to go harder, go faster, do more, I find ways to make my time more efficient, my life less stressful, my schedule more manageable. Yes, a cup of coffee is still necessary occasionally during a bad call night. A diet coke is sometimes still needed to get me through lecture. But when I get tired, I think about how I can change things at home to get more sleep. As a teenager I thought that sleep was such a waste of time. All it did was eat hours of potentially productive time out of my day. Now, I see sleep as healthy, and honestly, enjoyable.

I've also changed my priorities. My family is infinitely more important to me. Yes, I want to be a good doctor. Yes, I want to do well on boards and in-training exams. But I'm not willing to sacrifice my health and sanity for it any more.

I'm perfectly okay being just an average smart person.

Motto

We have an unofficial motto in our house.

Delayed Gratification.

In fact, since we don't even have an official motto, we could just promote this one from its unofficial status, but I don't think we'd attract more guests to our dinner table with "Delayed Gratification" painted above the door.

Our lives have been about waiting. With the idea (and hope) that all that waiting pays off in the end.

We've watched friends and family travel. Buy new cars. Buy new houses. Have the latest technology. Have even no-so-latest technology that we still didn't have.

Hubster and I haven't traveled. We drive at least one of the ugliest cars in the parking lot. We don't have smart phones, laptops, or fancy mp3 players.

We watched our friends drive their shiny new cars and go on their exotic trips. And then we went to class.

I was the girl in high school who had the detailed 10 year plan. The girl who knew exactly what she wanted. Amazingly enough, I've stuck with that plan.

My 10 year high school reunion is a couple of months. And although I won't be able to go, I'm proud of what I've accomplished in that time frame.

There have been times when it has been unbelievably tough. Times I wasn't sure we were going to make it. Times that I curled up on the kitchen floor and bawled my eyes out about how hard it all was. Times we've looked at the bills, looked at the bank account, and then back again, not sure how to make the math work.

It will all be worth it.

That's what we've kept telling ourselves during this long path.

That giving up all that extra time, that going one hundred thousand dollars in debt for our education, that just waiting would all be worth it.

It seems like we've been saying that for a very long time.

Yes, my 10 year plan is now a 15 year plan. But I've already done the first 10 years. There are only a few more.

One day, I was venting to my mom that I felt like I was giving everything up, and it seems so easy for other people, and how could I keep going when it would take so long, and I'm going to be 30! Well, someday. Her response has kept me going. All those years are going to pass. One way or another, they are going to pass. I'll be 30 whether I went to medical school or not. I'll be 30 whether I did residency or not. So, since I'm going to be 30 someday, what did I want to do with the time it took to get there.

I would rather put my shoulder down, work hard, be a doctor with an amazing family at the end of that time rather than have spent the time driving a (now not) new day and having (no longer) new technology.

Delayed Gratification.

We teach it to our boys.

That sometimes, the things you have to wait for are better than the things you can have right now.

On second thought, maybe I will paint it above the door.

At least now I know better

Last night at dinner, Bug said something about "salmon skiing." We were confused for a moment, and then realized he meant "slalom." We had a good laugh, especially as I remembered I had thought the same thing as a kid.

It got me thinking about other misperceptions I had as a child. Obviously, there are a lot. We all have them. Many of them are just based on a blissful ignorance of the world.

But a couple have stuck with me, just because of how silly they seem now.

When I was little, I used to ask my mom what my name was going to be when I grew up. Katherine seemed like a little girl name. I didn't know any grown ups named Katherine. I was convinced that when I grew up, I was going to get a proper, suitable adult name. Like Kimberly.

Just like my boys do now, I remember getting into bed with my parents. And when my dad was out of town, it was the biggest treat to actually be invited to sleep in my mom's bed. But she would always joke about how much we moved around at night. This translated in my mind that grown ups must sleep very still. I used to practice lying in bed at night, on my back, with my arms and legs straight. Not moving. Of course, I never woke up in this still, stiff position. But I kept practicing. There was no way I was going to bother my future husband with my moving around at night.

When I was about 7, the most wonderful thing in the world was to grow up and be a teacher. And in my mind, from having a literary diet heavy on Laura Ingalls and Anne of Green Gables, I was sure there was nothing more wonderful than teaching in a one room school house. Little did I know I was at least a century too late for that.

But at that time, I was pretty sure we would have flying cars by the year 2010, as well.

No Bed of Roses

(Confession Wednesday brought to you by Karen)

I have a presentation tomorrow. Which meant, although I was sick at home with the worst migraine I've had in years, I spent my afternoon researching radiographic evidence of pneumomediastinum. I couldn't make it up if I tried.

Between this, and the fact that I start internal medicine wards on Monday, I'm not really liking my job right now.

It can be very satisfying. And it pays the bills.

And it is not the worst job I have had.

That honor goes to to the time I worked taking orders at a flower shop.

Let me set the stage. I was still in college, and pregnant with Bug. We lived in the tiniest apartment known to man (the refrigerator door nearly hit the opposite counter when you opened it.) Money was tight and with Bug due in a few months, it was about to get tighter. Hubster had just barely left his construction job to start at a dental product company. Since he was new at the job, he was getting paid entry level. A raise was months away. So, despite the fact we didn't want it to happen, I needed to take on a part time job. It needed to be flexible because of my class schedule. It needed to be close by (because I didn't have a car.)

It was about this time that Hubster's aunt mentioned she worked at a flower shop close to where I lived and I should work there with her.

Now, I had in my mind a very romantic view of flowers. Let's blame it on Bed of Roses. It's always been a very small daydream of mine to own a flower shop. So I jumped at the opportunity.

Right away, I could tell the owner and I were not, well, kindred spirits. He said, "First thing you need to know. The customer is NOT always right. In fact, they are usually always wrong. Keep that in mind when you deal with complaints." Great.

He said, because I was going to work taking orders, I would be paid straight commission. No hourly base rate. He said most people earned so much this way, it didn't matter there wasn't a base rate.

I started the week of Valentine's Day. To say it was busy was an understatement. I was on the phone non-stop. And then, Valentine's Day passed, and it was slow. I spent time between calls studying calculus and battling morning sickness.

And avoiding my co-workers. Hubster's aunt was always trying to get me to go to the bar across the street for lunch with her for a couple of drinks. Hey, I'm pregnant over here.

The lady with the desk across from mine talked about all the jobs she been fired from because she kept sleeping with people. And then, a couple of weeks later, she called her husband to ask if he would take down the inflatable Santa and plastic candy canes out of their yard. It was March.

And my boss? Well, he didn't grow on me. I always answered the phone, "A-- Flowers, your FTD associated florist. How may I help you?" My boss didn't like this. He put a memo, a typed memo, in every one's boxes that said

Some employees have been overheard to answer the phone, "A-- Flowers, your FTD associated florist. How may I help you?" This is incorrect. The correct way to answer the phone is. "A-- Flowers. How may I help you at your florist associated with FTD?"

Huh? How is that better? How does that make sense?

And he couldn't just tell me he didn't like it. He had to send a memo to every single employee.

It didn't take me long to start hating the job. I hated my co-workers. I hated the fact I sat in a cubicle answering phones. I hated that I hadn't seen a flower since I started working there. And no one resembled Christian Slater.

And then I got my paycheck. The whole commission only paycheck.

I had made $3 an hour. Three.

I quit the next day.

Change of mind, not change of heart

It has come to my attention as we make the round, saying goodbye to friends and family prior to our big move, that many are unaware of the change in my career path.

The majority of people still think (or thought, prior to being corrected) that I am going into pediatrics.

And when I tell them that, no, I'm actually going to be an anesthesiologist, there is the unavoidable explanation.

I'm always met with variations of the same conclusion.

"So, now you hate kids?"

I thought I would take this opportunity to explain why I changed my mind.

When I first went to medical school, I thought that I was going to be an anesthesiologist. For all of two weeks.

We had a lecture series for first year medical students that taught us about different specialties. I was very excited for the anesthesia lecture. But the physician giving the lecture ruined it for me. He kept saying how great it was because you got to be a doctor, but you didn't have to talk to people. I knew that I wanted to interact with people (if I hadn't wanted this, I could have just stayed in my plant lab.) So I left the lecture and never thought about anesthesia again.

After my first pediatric rotation, I was sure that I wanted to be a pediatrician. I loved the children. And the normal hang-ups that people have about pediatrics didn't bother me. Sick children didn't depress me. Demanding parents didn't irritate me.

(Okay, I also really wanted to be an OB/GYN for a while. But I had vacation right after my OB/GYN rotation, and realized how much I liked my time off.)

I also strongly believe in primary care. Being the portal into health care and the first point of interaction, continuity of care, and care of vulnerable populations all appeal to the idealist in me.

So, I created my schedule to best prepare me for pediatrics.

I took pediatric neurology and pediatric IV team. Then I took my pediatric sub-I. (Background: a sub-I is an opportunity for a fourth year medical student to act similarly to an intern (or first year resident) They get more autonomy and more responsibility.)

My sub-I was the most miserable experience of my entire medical school. I was abused by the other interns. I never got to sleep on my call nights. I was told that no one would cover my patients if I went home early on post-call and "golden days" (paperwork only days.) I was so emotionally beat down that I was close to a mental break down. I told my friends, my adviser, and my family that I was going to quit. I couldn't see any end in sight to the emotional disaster that my life was becoming.

One day, near the end of my rotation, I was rounding on a patient that had a severe intestinal condition. His parents had been at the hospital with him every single day since he had been admitted 13 days earlier.

I suddenly realized that I was envious of those parents. Yes, their son was sick. But at least they got to see him. I hadn't seen my children awake in over two weeks.

I came to a realization right there that I liked my children much more than I would ever like anyone else.

I knew that I couldn't do pediatrics. But I didn't know what else to do - besides quit.

About a month later, I rotated in anesthesia. I immediately was drawn in by how happy everyone seemed. Yes, they worked hard. Yes, the work was stressful and demanding (but honestly, in medicine, what isn't.) But they didn't have the same beat-down, lifeless look to them that other residents had. And they had a life outside of medicine. Residents and attendings would talk about movies during cases. Residents had time to see movies?!

And at the end of one day, when I was told that I could go home, I was shocked by how fast the time had gone. I hadn't been constantly checking the clock. I wasn't resentful of the time I had to spend at the hospital.

A week later, Hubster asked me what rotation I was on. Anesthesia.

"Well, you should do this. You haven't asked to drop out for weeks!"

Since then, I have completely fallen in love with anesthesia. The procedures, the physiology, the pharmacology. Everything was intriguing.

When I first told some of my classmates that I was going into anesthesia, there was disbelief. "But you have such wonderful bedside manner. It will be wasted in anesthesia!" "But, what about your feelings on primary care?"

I still get to talk to patients. The better the bedside manner, the fewer sedatives required before surgery. I'm the last one they get to talk to about their fears before going into the OR. I'm the last face they see as they fall asleep.

And I realized although I love the idea of primary care, it wasn't the right avenue for me. I may not ever practice in a small, rural clinic, taking care of people no one else would otherwise, but I still get to be an advocate for my patient. I can make suggestions for better pain control, for better nausea prevention, for faster recover.

I can still be there for them.

A better introduction

Residency is just a little over a month away.

I've been trying not to think about it. I've been so happy during my time off. Playing with my boys, picking Bug up from school, reading to Monkey every night, catching up on my own reading.

I knew that it, like all vacations, wouldn't last. But it is so easy to pretend.

My first year, or intern year, contains a variety of clinical experiences. So that I have a broad variety of experiences on which to draw when I start dedicated anesthesia training during my second year.

I start in the emergency room.

I think my biggest fear about starting residency is being taken seriously. It never really happened during medical school. No matter how often I introduced myself as "Katherine, the medical student on the team," I was consistently called something else by patients.

Nurse.

Now, I'm not trying to belittle nurses or say that I'm better. Because without nurses, there could be no doctors. But the point is, I'm not a nurse. I'm a doctor.

Many school makes their medical students wear short, hip length white coats. This was to help differentiate medical students from residents and attendings. My school didn't do this. I wore a long white coat like everyone else. But despite this, I was never once "accidentally" called doctor.

Only nurse.

When people would ask what I was in school for, I would respond, "I'm in medical school." I got the same reaction from acquaintances, relatives, and strangers on the bus. "Oh, you're going to be a nurse!"

No. I'm not.

Once when I was admitting a patient from the emergency room, his cell phone rang. He answered it, talked for a moment, and then said, "Sorry. I need to go. There's a really pretty nurse here asking me some questions."

I know which emotion was stronger. I was flattered that he had referred to me as "very pretty" and not "nurse who looks like she hasn't slept in days, had time to comb her hair, and has the biggest, darkest circles under her eyes I've ever seen." But I was frustrated that he just assumed I was a nurse, despite my careful introduction.

It's not just my gender that have worked against me being taken seriously. It's my age. Or more accurately, my perceived age.

I think I can sum up this problem accurately with a single patient encounter. I had entered a room to place an I.V and take a patient back to the operating room. The patient turned to me before I had time to introduce myself and patted my arm.

"It's so nice they let high school students volunteer here."

Aww, thanks.

In the past, being seen as something other than I was and younger than I was made me timid. No one took me seriously, so I stopped seeing myself seriously. It wasn't until the end of medical school that I started to get a little confidence back.

This time around, I'm going to try to not let this past experiences hinder my confidence in anyway.

And this time, I can actually introduce myself as "Doctor Katherine." Maybe that will help.

Through and Through

Whenever Hubster and I hear anyone refer to themselves as geeks or nerds, we just laugh.

Because we know the truth.

They have nothing on us.

It took a while, but we have completely accepted that we are true nerds, through and through. And now, honestly, we are quite proud of it.

I was a biology major with a minor in chemistry. Hubster got a double major in mathematics and physics. I was president of the science club in high school, winning silver metals in state competition. Hubster led his class to a championship in the "Knowledge Bowl."

And we are doing the best we can to instill these precious attributes in our boys.

They have a model solar system hanging from their bedroom ceiling. We encourage them to "play" on Google Earth for computer time. We spend afternoons at museums. Family movie night? Your pick: Planet Earth or Blue Planet. And for fun...

"Guess what we're going to do today?"

"What?!!!"

"Grow salt and sugar crystals!!!"

And that's what we do. And each day, they would oh and aw about how much the crystals had grown. Until finally it was the day to take them out and eat them.










And then I saw these flash cards on Uncommon Goods. And I WANT them for my two year old!



This is all for their own good.

With a physician mom, and a dad applying for dental school, being a nerd can really pay off. Well, we hope so. Someday.

I'm done with waiting

After all the drama and build up, the match is tomorrow.

The not knowing is truly the worst. Worse than where I might end up. Worse than not getting my first choice. It's just going months and months without knowing. Not being able to plan.

I'm not as nervous as I thought I would be. I think my brain has shut off just a little. The real nerves will come, I think, tomorrow morning, as I'm holding my envelope with my family.

I'm trying to keep perspective about this. Building up to this day, it feels like Match Day is the most important day of my life. But it's not. It will never compare with my wedding day, the birth of my sons, or even the day I was accepted to medical school. This, instead of being a milestone, feels a little more like a speed bump. Just one more hoop to jump through.

The agony of waiting isn't anything like trying to create the rank list. That was hard. Every aspect of compromise, everything that marriages and relationships are founded on, was put to use.

Early on in the interview process, I thought I had found my perfect program. I loved the program. I loved the people. I loved the city. If they had offered me a position right then and there, I would have taken it without a second thought. I called Hubster in delight. "I've found it!" I said gleefully.

However, it was not to be. The graduate program there was a poor fit for Hubster. As in, not a snowball's chance. So, sick to my stomach, I tried to put my dream program out of sight, out of mind.

Everything worked out. Later in the interview process, I went to a program that, well, just felt right. The more we thought about it, the better it felt. In fact, it felt right enough of both Hubster and me that I was able to easily forget the initial dream residency.

That's what tomorrow is really about. It's the culmination of sacrifices on both my part and my family's part. It's evidence that compromise works for everyone.

And most importantly, it's the end of the waiting.

Just a little nervous (the real nerves come later this week)

Tomorrow I get an e-mail to tell me if I matched or not. Not where. Just yes or no.

If yes, my nerves will settle down just a little. If no...well, if no, I plan on just crawling back into bed and crying and maybe or maybe not plan on rejoining the world in the future.

Actually, I won't get to. Because I will be very busy being involved with the infamous "Scramble."

Where poor fourth year medical students who didn't get a residency position fight it out for any remaining open slots across the country. A two day process involving a lot of phone calls, waiting, and further hits on your self esteem.

I really hope that doesn't happen. How terrible to work this hard for this many years and not get a residency position. And possibly end up somewhere you've never heard of and don't know anything about.

Or worse, end up in a different specialty all together. To not be an anesthesiologist, but a family medicine doc or an internist.

Here's to hoping for the best.


-This is cross posted here-

The Next Step

Next week, my fate is decided.

It's something called "the Match," a complicated process in which fourth year medical students are giving residency training positions.

(For the "complete" inner working of the process, see here.)

And it happens next week.

And you can all be incredibly grateful that you don't live with me. Because this is all that I have talked about for months now. Hubster is sick of it.

I have been waiting for this day for years. As soon as I was accepted into medical school, my mind immediately skipped forward, like it always does, to the next step: residency.

I took specialty questionnaires, and then researched residencies for the specialties the questionnaires pointed me to during first year. I thought I had made up my mind during second year and researched pediatric residencies (looking mostly at call schedules and insurance coverage.) Third year, well, I was too tired to think about it. But then fourth year again was spend studying residencies, first pediatrics, then family medicine, and ultimately anesthesiology.

After waiting so long, it's a little unbelievable that it is happening on Thursday. It's actually going to happen.

I'm a sloshing mess of anxiety, excitement, panic, relief, jitters, dread, and anticipation. Most of the time, I'm not sure which emotion is dominant.

Not knowing has held us all in limbo. "Are you guys going to the family camp-out?" Don't know yet. "Will you be able to come of vacation with us?" Don't know yet. "So, where are you guys going for residency?" Don't know yet.

A week from now, I will know where my family and I am going to be living for at least the next four years. A week from now, we will be house hunting for real, and not just wistfully. A week from now, I can start planning again.

A week from now, I will be one step closer.

Resolutions

I've been a little behind. Not just regarding posting here, but in things in general. And I suddenly realized that January is about to slip away.

And I realized that because I haven't posted any New Year's resolutions, people may think that I didn't make any. (It's still January, so the year is still new enough.)

I did make resolutions, but I'm hoping that actually writing them down will make them easier to keep.

So here it goes...

I will be softer. I will be gentler. I will yell less and listen more.

I will learn to bite my tongue. Just because something should be said doesn't mean that I have to be the one to say it.

I will complain less. I know that the year holds more difficulty ahead, but I did make the choices that lead to that. I will recognize my role in the difficulty and the role my complaining has on my family. I will do my best to minimize the latter and live up to the former.

I will be healthier. I will cook more meals at home, eat sugar less, take fewer second helpings. (Hopefully this year, more of the meals I make at home will actually appeal to the people living there.) I will try to have one fruit or vegetable at each meal. My boys like broccoli and spinach and nothing else. So I think those will work (That's a lot of spinach for one year though.)

I will stick to my exercise plan. I know that I feel better when I exercise, but I am always falling off the wagon. I'm great for the first two weeks, but, you know, something always comes up. Like my pillow. I will try to stick to it this year. I will try for 5 days a week, but at minimum do 3 days a week. (My goal with the last two resolutions is to lose 15 pounds by next Thanksgiving. I need to lose more, but by starting with 15 pounds this year, maybe it won't sound so overwhelming.)

I will take time to paint. I will paint at least one picture this year.

I will work on my sleep routine. I will try to go to be before midnight and wake up at a normal time, even on the weekends (but still reasonable. Don't expect me to be the one all wide-eyed and bushy-tailed at 7 am Sunday morning.)

I will plant a garden.

I will finish at least one of the scrapbook projects I have started. Maybe the planets will align and all four will get done. But I'm only promising one.

I will continue to kiss my children before I go to sleep, even if they have been asleep for hours.

I will continue to make snuggling, hugs, kisses, and silly songs part of our daily routine.

I will try to make a new friend and invite them over to my house. (This one is probably the most difficult one for me.) But especially as I may be moving to finish my medical training, I don't want my family living like hermits any more.

While I know that there are thousands of other things I could choose to work on this year, I'm pretty sure that this will keep me plenty busy. I made sure my list wasn't too long, so there will be plenty of things to work on in the coming years.