Unrealistic Expectations

I have a confession.

A while back, when I was out with friends, I made a comment in jest about not exercising. One of the individuals present was shocked. Surely I was joking, they exclaimed. After all, there can't actually be someone who doesn't exercise.

And there's the confession. My comment was not actually in jest.

I haven't exercised regularly in months. Since July, to be exact.

Actually, let me be completely honest here, because the term "exercised regularly" makes it sound like I might be exercising irregularly or at least infrequently. I don't want there to be any confusion. I don't exercise. At all.

I'm not proud of this. I had been doing so great the first six months of the year. But between my new work schedule and the million other things, I just wasn't able to keep it up.

I also haven't stepped on the scale once during the last six months. But I figure that all my clothes still fit about the same, so things can't be too bad.

But this isn't necessarily about the exercise, or lack of it.

It's about expectations.

When that person expressed their shock, I wanted to grab them by the shoulders and shake them.

What more do people want from me?

Any time I mention things like this, I get a variety of advice about how to fix things: wake up earlier, walk during lunch, etc. I've tried a multitude of things and haven't found anything that works.

I work full-time plus, I have two children and a husband, I help take care of our house, I study each night, I blog (although infrequently lately, I know). I don't know what else people expect from me. I'm home and see my children awake for 2-3 hours a day. I'm not willing to take time away from that, even to exercise. After my children go to bed, I study for a hour, and go to sleep for my 6 hours of sleep each night. I just don't think I can do more.

I know that I don't have to live up to anyone's expectations except my own. But when someone mentions something that I should be doing - exercising, taking time each day for myself, sleeping more, doing more activities with my kids, recreational reading - it triggers that little insecure spot inside. The one that always feels like I'm not good enough, I'm not doing enough, I can't handle things. The one that tells me now matter how much I accomplish, I'm still going to disappoint people.

I'm sure that eventually I figure it out. The schedule won't always be so tight, the days won't always be so long. For now, I'm going to keep doing what I'm doing, and let that be good enough.

How do you handle pressure to do more? How do you cope with what feel like unrealistic expectations?

A time out, of sorts

In the midst of everything, and I'm talking everything -commercialism, schedules, keeping-up-with-the-Jones, the holidays, finances, family, plans- in the midst of all this, I sometimes forget to take a breath, slow down, and think.


It's so easy for me to fall into my little pity parties, little moments of unhappiness that come so frequently and so subtly that I don't even recognize them for what they are.

I find myself thinking that maybe all I need to be happy is this one more thing, to make it to just the next milestone, to get to that next place in my life.

I mean, everyone else has a smart phone, a DSLR, a laptop. All it would take is a car with paint on it, a bigger kitchen, more storage, a new table, a bathtub that's not blue. The list goes on. If only I had this, that, or the other, then I could be happy.

All I need is to make it until I'm done with residency and then I can be happy. All I need is to make more money, and then I'll be happy. All I need is for my student loans to be paid off and then I can start being happy. All I need is to find a job after residency and finally, I can be happy. All I need is one more baby, and then, we can all just be happy.

These thoughts come and go with such frequency I hardly notice them and the accompanying emotions of unhappiness and discontent.

This Thanksgiving, I was missing my family so much that I started to fall into the little well of misery. Those little thoughts of "If only..." were there. If only I had a better job that I didn't work so much and had time to go to Utah. If only I had more money so I could afford to go to Utah. If only...And then I stopped. I stepped back and took a time-out of sorts.

I have a job.

I have a family.

I have family and friends to spend the holiday with.


After all, not everyone has a nice car or the latest electronic gadget. I get so weighed down by what "everyone else" has that I forget that it's not everyone else. It's not even mostly everyone. It's the few and the fortunate, a group that, even without all the shiny accessories, I belong to.

I'm not waiting until after residency to be happy. I will start being content now. After all, we have a roof over our heads, food on the table, and love in our home, blessings that too many go without on a daily basis.

I'm embarrassed by how easily I get caught up in the shallowness of it all. Maybe what I actually need is the same thing my boys sometimes need - a time out. Time to stop, think about what I'm doing wrong, and how to fix it.

This weekend has been a good time out. As this next huge holiday rush comes up, and I feel those moments of "If only I could afford this" and "Why can I just have that," I'm hoping that I can remember to stop, step back, and remember, I have what I need.


Now is a good time to start being happy.

Pigeonholing

Talk in the anesthesia resident lounge is random. It varies between griping about our work, talking about our families, debating on which Pandora station to listen to, and arguing about which temperature the thermostat is set at. It's loud, comfortable, and fun.

The talk the other day turned to blogging. One resident mentioned that his wife blogged. I instantly was interested. Another resident asked what his wife's blog was about. This struck me as odd, because I rarely think of blogs being "about" anything. They are about the person who writes them. They are stories, chronicles, and narratives about the life of the writer. There may be the food blog, the book blog, the fashion blog, but in general blogs are life blogs. At least the ones I read.

Anyway, back to the point...

The resident replied that now that they had kids, his wife's blog was just like any mommy blog, a collection of cute pictures and stories about family outings. And then he said, "She used to actually write things. Before we had kids. I liked it when she did that."

Instantly, I got on my high horse. I thought to myself, well, I have kids and I don't have a typical mommy blog. I still write real things. I was feeling slightly smug and superior, thinking of how I hadn't succumbed to being a boring "mommy blog."

Then I looked back over my archive.

And that's when the truth dawned on me.

I'm another mommy blogger. Almost all my posts for the last several months have been about cute pictures of my boys and synopses of our family activities.

Not that there is anything wrong with being a mommy blogger. The majority of blogs that I read are mommy bloggers. We have children, we love them, we want to share. There is nothing wrong with that.

There are many bloggers who describe themselves as aspiring writers. They blog as their creative outlet, as a way to hopefully be discovered. I'm not an aspiring writer, in the sense that I don't have any burning desire to write a novel or publish anything. But I do like to write. I actually completely overhauled my blog at the beginning of the year so that I could stop having just a mommy blog, and start having a "real" blog.

But what do you get? Apple orchards, family vacation, camping trips, and birthday parties. There is nothing wrong with those things, but I had hoped to share so much more.

I did start blogging to chronicle my life, and that is still extremely important to me. I find it is so much easier to capture moments and memories when I'm not limited by the size or number of pages in a photo album. I can narrate to my heart's content. I can involve you in the narrative. Now that I'm blogging less, the time I do have to blog I feel is spent trying to catch up on our activities.

I'm not sure why this bothers me. It's silly really. Mommy blogs are real blogs. Some of the best blogs out there are plain old mommy blogs. Mommy blogs that still manage to have plenty of content and heart and thought. I'm happy to have a mommy blog. But I still feel that too often, I'm leaving things out. Hubster and I have discussions over the dinner table about politics, environmentalism, responsibility, societal pressures on women, health care reform, organized religion, pop culture influences on our children...and none of that ends up here.

I guess the point is that it's hard to face up to your own hypocrisy. I've felt like there was something different about my blogging, but really, I'm a mommy who is frazzled, like most moms, and ridiculously in love with her kids, like most moms. And that's just fine with me.

But this realization does make me what to start writing more and to branch out just a bit. Whether my schedule and my bravery allow for that, well, we'll just have to see.

Where The Road Leads

While I love lazy days at home, hanging out in my pajamas, reading, watching movies, or napping, I'm definitely happiest when I'm on the go. I love exploring, going new places, whether it's a new city, a new restaurant, or just a new place to stroll in the evenings.

It's probably from all those times growing up, no money for "real family outings," our parents would load all of us into the car and just drive. We explored the coast while we lived there, and then the hills of Eastern California, and then the mountain ranges of Utah. Sometimes it involved camping, but most the time it was simply steering the car onto a road we'd never been on before and seeing where it lead.

Hubster is not really a fan of this type of outing. The only way he really puts up with all my exploring is if I can tell him where we are actually going.

I'll have to hand it to him, though. In the past, there was resisting and groaning and rolling of eyes. Now, when he sees me clasp my hands and say, "Do you know where I want to go?" now, he just asks, "Where?" I think it must be the crazed light I get in my eyes when I say this.

Even Hubster admits, we've had some great adventures. We've discovered fabulous new places. So, this weekend, when I said, "Do you know what I want to do today?" he just smiled and said, "Where are we going today?"


And that is how we ended up spending a slightly rainy, misty day at Maquoketa Caves.



It was one of those days, full of the sound of rain, the falling of leaves, the beauty of nature and fall.


It was one of those perfect days, the ones that you spend time trying to recreate, but just can't quite get it right the second time.


Every path lead to something more beautiful. Each staircase begged me to climb it.



In the end, it was our soaking jackets and cold feet that brought our exploring to an end.

I think that's what keeps me going, what draws me out on new paths. Those days. The ones full of adventure. The ones where I see the delight in my children's faces as they feel for themselves the thrill of discovering what is just around that bend in the road.

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.

There Are Days

Every time there was a rough time during my intern year, I looked forward to the time I would do anesthesia. As I drug myself though the tediousness and exhaustion of internal medicine and cardiology, I thought about how great it would be to leave it behind for anesthesia. I daydreamed how anesthesia would be all rainbows and daisies and sparkles and pink unicorns.

Well, it's not.

Most of the emotions that I'm dealing with I know are irrational. I know it's because it's all new and scary and will eventually stop being that way. But at the same time, it's hard to cope at the moment.

My days are tough. I leave the house at 5:30 am, so that I can be in my scrubs and setting up the OR by 6 am. I work until 6 or 7 pm. And by work, I mean flat out run, both physically and mentally. There is no way to work fast enough to satisfy either my attendings or especially the surgeons. And everything is so new that I fall asleep the moment I sit down at home. I've fallen asleep both at the dinner table and while reading bedtimes stories to the boys.

Everything terrifies me. I feel like I don't know enough, that I'll never know enough. Obviously, I'm not supposed to know every thing right now. That's why I have three years of anesthesia residency, to learn all that I need to. But every time I provide anesthesia (under the watchful eyes and trained hands of my attendings) I feel that there is no excuse for the gaps in my knowledge.

There are days when my feet hurt so bad from standing for 13 hours that I limp to my car. There are days when I'm at the hospital until 8 pm that I want to throw things and give up. There are days when things go wrong in the operating room, things that I do know how to fix, and I'm shaking so bad that I can barely stand up. There are days when I feel that I'm not cut out for this.

I kept looking forward to anesthesia because I kept hoping to feel that medical school wasn't a terrible mistake. That I can have something good so I can stop feeling that I've given away my youth, my energy, and precious moments of my childrens' lives for something that just wasn't worth it.

Do I think it will always be this hard? No. Eventually I will feel comfortable, things will be second nature, and I'll know what I'm doing. Do I think it will always be so discouraging? Hopefully not. I'm counting on it not. Do I think it will be worth it? This is the question that takes more faith that I have some times. I hope so. I need it to be worth it.

Dressed Up

I have developed a new love. One that may actually be healthy for me, as it doesn't involve anything with butter, cream cheese, or marshmallows. One that allows me to show the feminine side I try to cultivate in my house full of boys. One that shows my softer, romantic side.

I've started wearing skirts.

Previously, I was a skirt-hater. A livid, staunch skirt-hater. I hated how fussy they seems (as I always thought before I needed pantyhose and a slip.) I hated how confining they felt. I hated that I had to be a little more careful in them, as to avoid giving the public a free show. They felt like the worst thing in the world to be chasing two little boys down the aisle of Walmart in. I hated that they were either skimming the floor (making me trip over them) or above my knees, exposing my most disliked body parts.

I had not worn a skirt voluntarily for years.

Last December, we were invited to a formal Christmas party. And due to the previous skirt-hate, which was also dress-hate, I had nothing formal adult holiday gathering appropriate. I didn't own a "little black dress." I didn't even own a giant tent shaped dress. I had nothing. So I swallowed my angst and went out to buy a simple black skirt to go with an absolutely fabulous Ann Taylor blouse that I adore. One that didn't scream nunnery or street walker.

When I came downstairs dressed in my skirt, ready for the party, I actually thought I looked kind of cute.

But it was my boys reaction that cliched everything.

They were speechless. Bug and Monkey didn't remember ever seeing me in a dress. Their shock quickly changed to delight as they clamored about pretty I was. Monkey was darling as he squealed, "Spin around, Mommy! Dance with me! Dance with Bug! Dance with Daddy! Dance with my dog!!"

Since that time, I've developed my own little love affair with skirts. I can admit that I was wrong. I've come to realize that skirts are easy to wear, casual as well as dressy. And I can still tackle a three year old and strap him into a shopping cart while wearing a khaki skirt as I can wearing jeans.

I'm enjoying my new fashion love...


...And the look on Hubster's face when he saw me in the dress I got for our anniversary.

Likable

I like to think of myself as a likable person. A nice, friendly, easy to get along with person.

(I'm sure if you cornered Hubster, he could tell all sorts of tales about my strong opinions and meltdowns and other things that can make me not-so-nice of a person. But I'm talking about generalities here.)

I'm pretty easy going, non-confrontational, and like I said before, nice. At least that's what I want to think.

Several months ago, I had a very difficult time during residency. I vaguely mentioned it here. Most of that difficulty was because of one person. A single person that did all they could to make my life miserable. At first, I thought this person was just a rude, unhappy person. After all, I had seen them belittle nursing staff, condescend pharmacists, humiliate medical students. But as the month progressed, the meanness, while still generalized, was more vindictive when directed towards me. And it hurt. Initially, I tried apologizing for whatever I may have done to frustrate them...not work hard enough, not study enough, whatever. But no matter how hard I worked, this person only became more difficult to work with. It got to the point they were sabotaging not only my professional appearance, but my ability to safely take care of patients. I talked to senior members of the team, without any success. By the time it came to attention of administration, I had gone off service.

Here's the point where I have to be honest. I've talked about my horrid experience with this person to my colleagues. I've mentioned their name. I did nothing to repair any of the damage that was done.

For months, I've known that someone in the hospital hated me. Luckily, being in different specialties, we haven't seen each other.

Until now. We ended up on the same service for (thankfully) a brief time. I had been dreading this for weeks. And the first day, it was every bit as awkward and painful as I thought it was going to be. This person didn't even acknowledge that I was part of the team, or even in the room.

Every instinct I had wanted to go and apologize for the terrible interaction we had so many months ago.

But I didn't. Although I may have been wrong in sharing the treatment I received with so many people, I know for a fact I did not deserve that treatment. But it is obvious that this person still can not stand me.

And this is what makes me wonder.

I've had some unpleasant interactions throughout residency. Where people just don't like me.

So, I like to think that I'm nice, likable, and friendly. But maybe I'm not as likable as I think I am. Maybe I'm not as sweet as I try to be.

I just can't stand the thought there is someone out there who doesn't like me. I know that person will never like me. I doubt there is anything I can do to change their opinion. And maybe, in this case, I'll be okay with being unlikable. Because here, the alternative doesn't feel good either.

Blog Love

I've been a terrible blog friend the last several months.

I've received awards, and haven't acknowledged them at all. I'd like to say I've been busy, but that excuse only carries so far. But believe me, I'm going to milk it for all it's worth.

My deficiency in acknowledging awards does not correlate at all with my excitement in getting them. It makes my day.

So, I'm going to step up and be efficient!

Gina sent this darling blog award my way.


The rules for this show of blog love is to share 10 things I love.

1. Summer. I can not get over how much I love that it is warm outside. That the sun is up before I leave for work and is still up when I leave for home. That we can run around in bare feet. This is my favorite time of year!

2. My new dress. This deserves its very own post. But I have a new found love of dresses.

3. Pink toenails. I let my toenails go au natural during the winter months when my feet were constantly covered with thick socks and boots. But with the warm weather comes sandals and flip flops. So I'm back to my pink nails. And I smile every time I see them.

4. Lists. There is nothing that brings the same satisfaction as making a list and then getting to cross things off of it. Lists make me feel organized, efficient, and thorough. It may just be a mirage, but at least while I'm making my list and crossing things off it, that's how I feel.

5. Farmer's markets. It's that time of year again. I love strolling past all the vendors, looking at the vegetables and flowers and fresh breads. I love seeing things like rhubarb, and purple asparagus, and organic arugula and buying what is available and coming home and being inspired by what I bought.

6. Dusk. There is nothing like dusk in the summer. We get the boys out of the house and stroll down the sidewalk, talking, catching up on the day, and enjoying that beautiful, transient time of day.

7. Peeps. I think this stems from my love of marshmallows in general. But I love Peeps. Not only are they marshmallows, but they are cute shapes in different colors. And now they have them for almost every holiday, not just Easter!

8. Antique stores. Oh, I love antique stores. Even if I don't end up buying anything, I usually just have to pop in and look. It feels like things I get from an antique store for my home just mean more than things I get from a chain store. And since the items usually require a little elbow grease, it also feels very personal.

9. The smell of my boys coming after a bath. Okay, it's true. There are times, no matter how clean they are, that little boys just have a smell somewhat reminiscent of wet dog. I don't understand this at all. But after a bath, when the smell of daycare and the classroom and the cardboard box fort have been washed away, the smell of their clean hair just makes me feel all soft inside.

10. The beach. Just give me a beach. I'm not really that picky. It's my favorite place in the world. I always thought I would end up living by one...and now I live in Iowa.

I'm going to pass this award onto...

Julie at He Who Laughs Last
Rita at Fighting Off Frumpy
Leigh at Leigh vs Laundry
Crissy at Life as a CEO
Heather at Theta Mom


I received this from Kim, longer ago than I can admit.


For this, I'm supposed to list 5 things I love. I'm going to make this 5 different things, just to make this harder on myself, and realize why procrastination never pays.

1. Mangoes. I think I avoided this fruit for a very long time because of a bad experience or impression as a child. I can't even remember the details. But now, I feel like I can't get enough. Fresh mangoes, mango juice, and dried mangoes. Yum, yum, yum!

2. Post It Notes. This things are great. I've got three stacks of different colors on my desk right now. I write random thoughts and just slap them on the wall...silly things the boys say, thoughts for posts, quotes I love. Then, when I have time, I can take them down. No tape, no giant sheet of paper. Just pure brilliance.

3. Scrub hats. Okay, I don't actually have any yet. I'm in the process of ordering them for when I start back in the operating room in July. But I'm sure in love with the idea of scrub hats. Not only do they come in nearly any darling pattern I want, no one will ever see my hair at work again!

4. Hydrangeas. These are by far my favorite flower. I had them at my wedding. And the great thing about Iowa is they actually grow here. I haven't planted any yet, due to the yard still needing some landscaping before the plants go in. But I've already picked out the perfect place.

5. Popcorn. Yes, I realize that this is the third food I've mentioned so far, but I'm convinced there is no better snack than popcorn. It's versatile, it's cheap, it's quick to make. And it's just down right delicious. In fact, I'm going to go make some as soon as I hit publish.

I'm passing this one to these great bloggy friends

Karen at A Peek at Karen's World
Gina at Namaste By Day
Colleen at Cheap Wine and Cookies
Brittany at Molly Lou Gifts
Sandy at It's a Jungle Out There

From Brittany, one of my newest blogging friends, came this blog award.


This one asks that I share 7 things about myself. Whew, this is turning into a lot of work. But, after all the blog love I've received, it's really hard to complain. It would be like complaining that my wallet is too small for my hundreds and my diamond shoes are too tight! (Bonus if you know the reference!)

1. Once I start a book, it is next to impossible for me to put it down. It doesn't matter what other things I have to do, how busy I am, how late it is. I just can't stop reading until the book is done. I have no ability to pace myself or make the book last longer.

2. On the other hand, I have no ability to stay awake during movies. I don't think I've seen the end of a movie in, oh, probably years. In fact, I haven't really seen that many middles of movies either. This drives Hubster crazy. But, seriously, I'm really tired, and holding still and relaxing in front of the TV is sleep inducing.

3. I have such a strong dislike of doing dishes that it prevents me from cooking. I actually love cooking. I love new recipes and trying new food. But most the time, all I can think about is that I'll have to clean and wash everything I use, so I'd rather just order pizza and use paper plates.

4. I've read Pride and Prejudice once a year for the past 7-8 years. One year, I read it twice. The story just never gets old.

5. I have a complete irrational fear of potlucks. I hear the word and I get sweaty palms. Or get-togethers or company picnics where people say, "Oh, just bring a side dish." I panic. What am I supposed to make? What qualifies as a side dish? How much should I make? Will people even like this? What if someone else makes the exact same thing? I hate, hate, hate potlucks.

6. I have never had a pedicure. Except the ones I give myself. In fact, the only manicure I've ever had was for my wedding.

7. It's my dream to find a historic home, or an old farm house and restore it. I just love the thought process and the decision making. This idea, unfortunately, stressed Hubster out. Just fixing up our current home stresses him out. But me, I love it!

This award, I'm going to give to...

Liz at Eternal Lizdom
Kim at The Mommy Machine
Trina at Trinabug's Life
Megan at Twinsomnia
Melissa at Random Ramblings

Every one of the bloggers I mentioned are amazing bloggers. If you have a moment, stop by and say hello. I just can't get over what an amazing community this is, the unbelievable women that are part of it, and the fantastic friends that I've made.

So, about yesterday...

I have a hard time explaining to people why I blog.

Things I've heard about blogging...So, isn't it just like Facebook? or What? You mean, you don't actually know any of these people? or Aren't you busy enough without blogging?

If you are not a blogger, it's hard to explain that it's not like Facebook. And although I haven't physically met any of you (except you, mom!), I feel like I do know you.

Sure, I might have more time to do other things, like clean toilets, there is no way I'm giving up blogging.

Today has shown me that.

Trying to go to sleep yesterday, all I could think about is how I shouldn't have published yesterday's post. First of all, it will make my mom worry more than she already does. Second, I shouldn't unleash my bad days on the blogosphere; it hasn't done anything to deserve that.

But maybe, more than anything, I was just plain embarrassed.

For the love of all that is holy, I'm a effing doctor. I should suck it up and deal and stop moaning about the whole thing.

I thought about erasing the post, but that would have involved getting out of bed. So I let it stand.

And this is why I love blogging.

I don't know you. But that hasn't stopped you from sending me words of encouragement and support, from sympathizing with me, and for being wonderful blog-friends.

Because that is what I call you to Hubster, "So, my blog-friend said...." He knows what I mean.

It's strange, but the people I've "met" from blogging have become better friends than many I have in real life. I guess that could be read as I have a pathetic social life (which may or may not be true.) But I think I speaks to the amazing people that are part of this community.

And I just wanted to say thanks.

Approaching The Burn

I have just over a month to go before intern year is over, and the only thought I have is I don't know if I can keep doing this for three more years.

Between the third and fourth year of medical school and one year of intern year, I've already been doing this for three years.

And I'm not sure I've come out better on the other side of those years.

Right at this moment, I'm so beat-down and burnt out that it's hard to care about anything. I'm tired. It's hard to sleep at night, because all I can think about is that I have to get up and go to work. Again. And again. And again.

It's been months since I've had two days in a row off.

I know what the signs of burn-out are, and I'm pretty sure I'm checking off the boxes. My performance at work is suffering. My motivation to study is minimal. I'm just doing what is required of me and not much more.

And the thought that I'll keep feeling this way for three more years makes me just want to quit right now.

Except I can't. Because someone has to pay the mortgage and bring home food.

As I was having a mini-meltdown last night, Hubster made a remark about regretting going to the particular medical school I went to. I told him it wasn't the school I regretted, it was medicine in general. I've become a statistic, one of the many doctors that say, given the chance, they wouldn't do it over again.

I resent what my education and training have done to me.

I like to think of myself as an optimistic person. I like to think that I'm an idealist, a dreamer, a hoper. But I'm not sure how much of that person is left. My training has been the optimism and joy right out of me.

There is a reason the depression rate and suicidal ideation are so high among physicians (Great article about it here.) The path through this is difficult. Like a fellow resident-blogger wrote once, "When it is bad, it is very bad. And when it is good, mostly, it's just OK."

But don't worry. I'm okay. I may be burned out, but I'm not depressed. I may not be happy at work. But I still have plenty to have happy about.

See, things at home, well, they are the best they've ever been. Even if Monkey is going through a particularly naughty phase that includes dumping all the drill bits under the deck. The boys are happy and healthy. Hubster and I have reached a new level of communication and love in our relationship. Coming home every day feels like reaching harbor after a journey. I feel like a different person at home. One that has nothing to worry about except being tackled during a game of tag.

Maybe it is the happiness at home that makes going to work so very hard.

There is a resident that I'm working with right now that is still so happy and thoughtful and energetic. I don't know how he does it. Maybe his training up to this point has been different than mine. And then I am envious. Envious that he is happy, when I just can't seem to be. Envious that he is content, while I am trying to survive. Envious that he is still optimistic, idealistic, and hopeful.

But there are times, even when I'm not sure how I can keep going, there are small moments, that I think, maybe, the old girl I was is still in there.

Happy Endings

I realized something about myself while watching LOST last night.

And no, it's not that I'm incredibly nerdy, and love thinking about the space-time continuum, or string theory, or throwing out facts about dominant hemispheres (did you know that the majority of left handed people are still left-hemisphere dominant?).

All that, I already knew.

What I realized last night was that I love happy endings.

As I watched in horror as more characters tragically died (no spoilers in case you're a fan, and haven't seen it yet), I realized that all I wanted was for them to escape and be okay.

I'm a happily-ever-after type of girl.

I hated the third Pirates of the Caribbean. Yes, At World's End had the shocking ending that you didn't see coming. Yes, I realized how delicious Orlando Bloom can be.


But it wasn't how it was supposed to end. Will Turner and Elizabeth Swan were supposed to end up together. After watching three whole movies, I don't want to find out that the love story I've been swept up in didn't actually happen. Would it have been predictable? Maybe. But so much more satisfying.

There were many critics of J. K. Rowling, saying that she should have killed off Harry Potter in The Deathly Hallows. It would have been a more interesting story, a more unexpected ending, a less cliched "good conquers evil." I, for one, am glad that she didn't. Harry Potter had been my literary companion for years. I don't know if I would have ever been able to pick up the series again, if I knew the unwilling hero died at the end.

Unhappy, shocking endings, or the boy doesn't get the girl, or the hero doesn't save the day. Maybe the critics are right. Maybe it is more realistic. But isn't that the point?

There are plenty of sad stories out there. I work in a place were behind every single door is a another sad story. Some stories so sad, with no chance of a happy ending, that they take my breath away and leave me reeling. Life itself is so full of sad stories, with unexpected endings. I don't need real life from my movies, TV shows, and books.

If heroes and main characters aren't allowed their happy endings, what chance is there for the rest of us?

Maybe happily-ever-after is predictable. Maybe happily-ever-after is cliche.

Who cares?

I want my happy ending.

Dealing

A ubiquitous question on the interview trail, whether for medical school or for residency, was "How do you handle stress?"

I've given a variety of answers to this question. But thinking about it, I'm not so sure I even know what this question means.

How do I handle stress?

Does this mean, what do I do when there are stressful situations so I don't get stressed out?

Procrastinate, blog, watch as many Office re-runs as I can, sleep until noon. Well, that's what I would like to do, at least. I don't usually have the opportunity.

Most of the time, I just have to face stress head on. As in, Deal With It.

Which means I am stressed out. A lot.

So, does the question mean, what do I do when I am stressed out?

No one wants to hear the truth to that.

No one wants to hear that I get short-tempered with my family. That I find myself reading the same line in the text book over and over, and still nothing has made it into my gray matter. That I wake up at 2 am with my heart racing and can't get back to sleep. That I resort to eating handfuls of Skittles and neglect to cook my family dinner, or help with dishes or laundry.

That wasn't ever the answer I gave when I interviewed. Obviously.

But that's been reality here for the last couple of weeks. Ever since I decided that a couple of weeks should be plenty of time to study for Step 3 of the U.S. Medical Licensing Exam. A 2 day, 16 hour exam.

I've spent two weeks with my review book on my lab and my computer screen with thousands of questions in front of me. I've imposed a hermitage in our office and barked at anyone who dared enter. Or make too much noise in the hall. Or even, dare I say it, anyone who asked me to come to dinner. I've got my Skittles, I'm fine.

But I'm done.

And the January statistics report?

Weeks studying: 2
Hours a day: 5
Review book: read twice
Practice questions: 1250
Days testing: 2
Hours of testing in those 2 days: 12.5
Breakdowns: 1
Weeks waiting for my score: 6
Chances I'll have to do this again: ?

I know they ask that question on interviews to make sure you have some coping mechanisms (that don't involve rainbow colored candy.) They don't want to take on a resident that screams at nurses or melts into a puddle of tears in the middle of the ICU.

But I think a much more important question is this: "What do you do for fun?"

And that's this weekend is all about!

So, I'll see you Sunday evening. Right now, I've got two boys who are waiting to celebrate with me with a crazy game of Wii Bowling!

An Incomplete List

Give me one hour of uninterrupted alone time, and I know exactly what I will do with it.

There are abundant things that I should do with that hour. Do the dishes, do the laundry, sweep, sleep, exercise. There are countless things I enjoy that I could also do. Paint, Photoshop, catch up on my DVR recordings, listen to music, blog.

But the one thing I choose above all others?

Read.

Since I was little, reading has been my favorite activity. In second grade, I would grab a blanket and sprawl in the sun on our back porch with novels far too advanced for my age. I didn't understand the subtleties of the plot, the emotions were often beyond the range of my own experience. But the adventure, danger, and romance swept me far away from my 8-year-old life. Any given afternoon, I was exploring tropical jungles, settling the West, or attending balls in the courts of France.

AS a teenager, I would walk around the house with my nose in a book. It was propped behind the sink as I washed dishes, it joined me at the dinner table. And often, I would sneak into the bathroom for completely uninterrupted reading, only to emerge, sometimes an hour later, and usually to frustrated siblings. I could disappear for a weekend at a time, curled up in my bed, exploring space, surviving wars, or discovering radioactivity.

I read nearly every book of the reading lists for high school. I made lists of book to read, and methodically crossed them off.

As soon as I had money, I began buying my own books. If anyone draws a blank on what to get me, they get me books.

Now I horde them. Do not ever, ever ask me to throw out a book. It does not matter that our five bookselves are overflowing and stacked every which way with tattered paperbacks from the book exchange or shiny new hardbacks from the chain store. The books are not books any longer. Each one is a character, a personality, well known and well loved.

I even love the smell of books. Open a brand new book and the smell of paper is intoxicating. I used to study on the second floor of the university library, not for the silence, but for the inviting, soothing smell of the rows upon rows of books.

It is hard for me to come up with a list of favorites. I can name my favorite people or favorite songs much easier than I can my favorite books. But I will do my best.

Some are on this list because of the story, some because of the impact they made when I read them, and others, purely from the joy I have every time I turn the first page.

A Tale of Two Cities


In my mind, this is Dickens' best book. The imagery is breathtaking. The strength of the writing and the plot development never disappoint. Not once.

Pride and Prejudice


I love Austen. Her witty, nearly sarcastic view on women's lives at the time appeals to both my feminine and feminist sides. And there is no character that I love more than Elizabeth Bennett. She is both perfect and flawed, and therefore, completely human.

Harry Potter


Yes, I am counting all 7 as one book. I have read these books more than I have any other (although Pride and Prejudice does come close.) Rowlings mastery at weaving a plot that takes twists never expected, her brilliant character development, and the sheer magic (pun both intended and not) of the books make it so they captivate me just as much the seventh time through as they did the first.

To Kill a Mockingbird


Exquisitely painful and beautiful at the same time, the range of emotions of this book nearly overwhelm me each time I read it. There are few literary characters that make you want to stand beside them as Atticus Finch.

Crime and Punishment


Dostoevsky's examination of guilt, conscience, justification, and redemption are both frightening and captivating, without letting you be sure of which emotion is stronger.

The Hobbit


I was sure at one time that I loved science fiction more than I loved fantasy. Now, I'm not so sure. The one thing I am sure of is that I can trace my shift in feelings back to when I first read a story about a hobbit stepping out of his little round door and setting of in search of gold, adventure, and self-identity.

I think I should stop at 6. Otherwise, I will be perusing my library all night, reading through books and deciding if they should be on my list or not.

This is not be any means a complete list. Not even close. Mary Shelley, Ray Bradbury, Leo Tolstoy all belong on this list as well. Nor is it even close to being a list of books I feel are must reads. I'll save that for another day.

What books are on your "favorite" list?

Let me know, so that, given enough uninterrupted alone hours, I can add them to mine.

The healing process

Years ago, someone very close to me hurt me in such a way I thought I would never recover.

I'm not going into the details, because now, years later, the details themselves mean very little.

At the time, I felt angry, betrayed, neglected, and above all very, very sad. Heartbroken.

I know that this person never intended to hurt me. I understand that the circumstances surrounding the event may not have been possible to change. Even then, I knew that most of what happened was the perfect storm of bad events.

Knowing all that, I could have forgiven the person and moved on. However, one thing prevented me from doing this. It has prevented me for years from doing this. I have carried this hurt inside for a long time and it has severely influenced my relationship with this person.

The thing that prevented me from ever getting closure was this person's refusal to acknowledge what had happened. We both knew things probably couldn't have been different. However, in this person's mind, because he couldn't change things meant he didn't have to recognize the damage it did. Every time I tried to talk about it, all I was met with was justifications and excuses and even accusations. Why couldn't I recognize that it was the best he could do, and that should be good enough for me?

I eventually stopped talking about. I eventually stopped crying about it. I eventually stopped thinking about it all the time.

But it was always there, a giant gorilla that stood in place of our relationship.

I don't want anyone to think that I have spent the last many years carrying a grudge. It is not a grudge. It is such a big event for me that I needed to talk about it, and have only been met with resistance. And because of that, I felt I have never been able to start to heal.

My least favorite movie all all times is Love Story.


I felt it was less of a love story, and more of story of people using love as an excuse to treat each other badly.

"Love means never having to say you're sorry."

I don't believe that.

I think we are only truly sorry about hurting someone we love. And admitting a wrong and truly apologizing to a loved one is one of the most difficult things to do. Being able to say sorry, and mean it... now that is love.

Many people think that an apology is just words. That it doesn't do anything to change the action that happened. It's true that it doesn't go back and erase what happened, but it is not true that it doesn't change things. A true apology can be one of the most healing things there is.

During conversations with patients and patient families regarding bad outcomes, many of them say the same thing. They knew that things probably couldn't be different. They knew everyone did their best. But still bad things happened. The one thing many of these people wanted was an apology. Just to have their physician recognize what had happened and just say they were sorry. No defensiveness, no excuses, no justifications. Just an apology.

I had long given up on an apology.

Several days, I was on the phone with this person. We were talking, as we often do, about things that are "safe." Our families, our jobs. Then, out of no where, this person said apologized. Things have been rough for a very long time. And I'm sorry for that.

It was the first time in my life I have ever heard this person say "I'm sorry."

I'm not exactly sure what the apology was for. I'm not sure it was a recognition of the hurt I have been coping with for years.

What I do know, is that now, for the first time, there is a chance to start healing.

Two Options

Everyone can be an optimist when things are easy.

Okay, not everyone. Hubster is proof of that. I'll comment on what a beautiful day it is, and he will respond with something about how hot it will get, or how it won't last, or something else entirely pessimistic.

But it is easier to be optimistic when things are going the way they "should." When the boys are well-behaved, the cars both work, the weather is beautiful, and work is enjoyable.

This month has been none of those things. This month has pushed my ability to be optimistic to it's very edge.

My work this month has been more demanding than anything I have done previously. The people I am working with are some of the most difficult personalities I have ever encountered. My hours have been some of the longest I have ever put in, leaving when it's dark, coming home when it's dark practically every day.

The boys have reacted to my longer hours and other changes in their schedules by fighting more with each other. Monkey has had some regression in terms of sleeping and potty training. A lot of work around the house has fallen to Hubster, including the task of coping with the unwelcome changes in the boys' behavior. So Hubster has been a little more grumpy as well.

I've been so exhausted that my temper has been shorter, my desire to help cook and clean at home as been less. I come home and fall asleep shortly after, leaving little time to play with the boys (and even less time to blog.)

I dread going to work, mostly because of the people I'm currently working with.

I feel like I have every reason to fall into a pity party. There are days when I would just like to stomp my foot, and yell, and give up.

But I haven't.

I'm not saying that I haven't been grumpy. I'm not saying I haven't cried several times on my way home from work.

But I can't give up. I have to keep plodding on. And I have two ways I can do it. I can either cry, or I can laugh.

I'm doing my best to go with option 2.

And would you like to here something good about this month?

It's almost over.

Where we come from

I spent most of middle school and high school dreaming about attending an Ivy League school.

Of the onslaught of college recruiting material that arrived during the early fall of my senior year, the most treasured and poured over where pamphlets from Harvard, Yale, Brown, and Stanford. (Okay, I know Stanford isn't technically Ivy League. But still...it's Stanford.)

I kept those particular recruiting packets long after I accepted my full-ride scholarship to the local state university.

I graduated Summa Cum Laude from my local state university, with the highest GPA earned by a female in the college of science. And I dreamed of attending medical school at UCSF, Mayo, or John Hopkins.

I applied to one medical school, and enthusiastically accepted a spot at a state medical school.

I worked hard during medical school and graduated with honors and Alpha Omega Alpha (or AOA, the national medical school honor society.) I had spent all of medical school picturing myself attending residency at Stanford (yep, there it is again), Wake Forest, Vanderbilt, Mass General, or Mayo.

And then I matched into my top choice at a state program in the Midwest.

The decisions I made, compared to the ones I dreamed about, were made after weighing what was best for our family. There were times that I felt deeply disappointed. I had worked so hard, and had the ability to attend undergraduate, medical school, or residency at some of the biggest, most prestigious schools and programs in the country. But, for the good of my family (and ultimately even for the good of myself) I chose to attend less well known, more affordable state schools.

I wonder...does it really matter?

I attended public high school. I did not attend a rigourous, private, college prep school. But I still managed to get a full ride scholarship to a respected school. A state school, yes, but a good one.

I attended a state medical school. Many of my classmates had done their undergraduate at Stanford, MIT, Cal Tech, Yale, and Princeton. Those classmates had attended prestigious private programs while I had attended a state school. (And yes, I have on multiple occasions seen people say "state school" with a air of disgust or as a joke of mediocroty.) And yet, we had arrived at the same place in our lives.

I attended a state medical school, and now I attend residency along side individuals who trained at Brown, Hopkins, Cleveland Clinic, and UCSF. They did go to the prestigious programs. And yet, here we are, at the same point in our lives.

I never attended any of the places that filled my academic dreams as a teenager. And yet, here I am, the initials MD behind my name.

Does it really matter where we come from?

I don't want to belittle the experience of attending an Ivy League university. The culture and surrounding probably run deep and inspire.

But in the end, does it really matter?

Because in the end, where we go depends more on who we are then where we come from.

No Right Time

I come from a large family.

And when I say large, I mean "could have our own TLC show" type of large.

I'm the oldest of 10.

Yep, two whole handfuls of children. 12 of us all together, once you remember to count the parents.

I'll give you a while to take that it.

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There are some downsides to being in a big family. There never seems to be enough space forever one. Never quite enough money for everything. And occasionally not enough time.

But the challenges never beat out the joys of having a large family. There are always enough people for board games (just sometimes no enough pieces, and then you improvise. I'll been the top hat, you be the shoe, and you can be rubber frog.) Happy birthday sounds so much better when sung by an entire choir (except when the choir consists of a couple of teenage boys, and then you just take what you get.) And there are enough for two teams in soccer, baseball, or basketball. And with that many birthdays, most of the year is spent in celebration. I always had the largest cheering section at all three of my graduations.

Most importantly, we always had friends. I'm not implying we always got along. Some sibling rivalries were more obvious and intense than others. I had siblings I always fought with and siblings I never fought with. But we never felt lonely.

I love my huge, crowded, loud, talented, chaotic, supportive, drama-inclined family.

But one of the strange things about growing up in a large family is the mind set that starts to set in. We felt bad for children in small families that only had one or two siblings. Or, heaven forbid, no siblings!

I grew up viewing parents who had one, two, or three children as selfish. They valued their time, money, and leisure more then their children. Career or pleasure topped the priority list above family. Small families were created by horrid people who valued peace and quiet more than they valued providing siblings and friends for their children.

I was determined to never be selfish. I was going to have a half dozen of my own children and create as many happy family memories as I had growing up.

(Remember, I was young, and like many very young people was prone to black and white images and a slight inability to view things for others point of view.)

I realized very soon after Bug was born that I was never going to have a huge family. I seemed to lack the pulled togetherness, resourcefulness, and patience of my own mother.

I love my two boys with a fierce, mother tiger like love. I am intensely proud of them, and nearly worship them.

But I came to realize that I was not cut out to be a leader of a very large flock.

And this is where it gets difficult.

I would really, really like another child. Monkey is three. And I can start to feel the baby hunger set in. I haven't felt that, well, since we decided to get pregnant with Monkey. Even when Monkey was two years old, I could hold other peoples newborns, cuddle and coo at them, and not feel one twinge of envy or baby hunger. But since Monkey is now mostly done throwing fits in the grocery store, nearly sleeping through the night, and for all intents and purpose potty trained, my brain has starting letting those TV commercials with wrinkly babies get to me.


Hubster and I have started talking about what our schedules look like over the next couple years, trying to get a good idea about when would be a good time to have another baby.

But I'm looking at 50-80 hour work weeks for the next four years, laden with overnight call at the hospital. Hubster is just finishing up some last minute requirements for his application to dental school.

If we were to have another baby in the next four to five years, that baby would spend a lot of time the same way Bug and Monkey have spent the previous four years. In daycare.

And then we ask ourselves...who's being selfish now?

Is it more selfish to continue with our plans for our careers and future and be content with our two boys? Or at least postpone baby number three four years until I am done with residency, have a stable job with some control over my schedule.? (That would make Bug 12 and Monkey 8 before we had baby #3, just to do some math.)

Or is it more selfish to give into the baby hunger and the theoretical chance of a much wanted girl (who would be just as wanted if they were a boy, just to make that clear) when they would be raised 8-10 hours a day by someone else? Just because we want another baby and would love her (or him) passionately and intensely, could we provide what is best?

Bug and Monkey are turning into well adjusted little boys, who play well with each other and others. Bug does amazing in school. They love each other and know that they are loved. They have done this even with years attending daycare behind them and in front of them. So I'm not saying daycare ruins children, or damages childhood.

But is it best?

When people ask why we decided to have children while still in medical school, we always replied: There is no right time to have children. There will always be reasons to postpone, put it off, delay it. There is no right time.

But maybe there is a wrong time.

I'm not exactly sure what time it is now.

Screaming Inside

The last couple days have reminded me why I blog.

My thoughts have been running through my head so fast that I'm being whisked along behind them right onto the express towards crazy. They bounce around against my skull, getting louder and louder that I'm not entirely sure people around me can't hear them.

When Hubster and I were dating, I'd often ask him what he was thinking. Turns out, guys don't like to be asked this. And without fail, he would say "Nothing."

I don't ask he what he is thinking anymore. I can read his mood better than the TV menu. And as our relationship has grown, he shares more and more.

But I always wondered about the "Nothing" response. Is it the same as when someone asks me what's wrong, and I say, "Nothing." Because I don't what you to know. Or is it really "Nothing."

How could anyone be thinking "Nothing" when my mind is constantly going. When I'm not thinking about what's for dinner and did anyone get the clothes out of the dryer, and we still need to get plastic bins for the things in the garage before winter, I'm thinking do I really want to fellowship in Pain Management or should I just stick to general anesthesia, and how long would it take to tile around the fireplace, and does Monkey like his new daycare and why haven't I started saving for retirement, and it's been a long time since I've painted, maybe I should try to work in some time.

It's like this ALL THE TIME.

So I blog. I'm not always to get everything out, but at least a little. A pressure valve. At least to thin out the internal crowd.

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I'm never sure how much to share about work. Because I work in medicine. I feel that I can't just talk about my feelings and experiences, because I'm "representing my field." Can I talk about depression rates and the horrific grind of residency without you wondering if your doctor is depressed and therefore should they be taking care of you?

If I talk about doubts and mistakes I make in my training, does that make you trust medicine less? If I were to say that I felt 100% my senior was wrong about something, and so I went ahead and did what I thought was right and practically saved a patient, is that good or bad? Interns shouldn't be acting without supervision. What I did would not have hurt the patient, and definitely helped her, while doing nothing may have been devastating. But should I have acted of my own accord? Or should I have listened to my senior? Telling you this, do you trust the system less?

I believe in medicine.

I don't think we always make the right decisions. I know that people are hurt by poor decision making. Bad things happen, both due to unavoidable side effects or due to blatant over sight or negligence. It is one thing when your mail is delivered to the wrong address. It is another thing entirely when medicine is delivered to the wrong patient. Or procedures are done incorrectly.

But I still believe in medicine.

Western medicine doesn't have all the answers. I've seen more patients' pain managed with massage and acupuncture than I have with pain medicine and invasive procedures. I've seen patients defy all odds. I've seen families and patients alike get more benefit from prayer, blessings, meditation, and even withdrawal of care, than they would have from ongoing treatment.

But I still believe in medicine.

I may not agree with my training. I don't prescribe to the old school thinking of complete dedication to the exclusion of the rest of your life. I disagree with the hierarchy that's been created in the system. Training shouldn't involve humiliation, degradation, and exhaustion until mental breakdown.

But I still believe in medicine.

I've seen children walk who shouldn't have, because of surgery. I've seen women hold children they never otherwise would have had, because of medicine. I've seen people get a new lease on life after a heart transplant. I've seen infections cured, pain treated, bones set, and lives saved. Because of medicine.

I believe in medicine.

What I write is my own experience. I have bad days and heart-breaking moments. I battle egos as frequently as I do fevers and low blood pressure. I have been through bitterness, depression, and fatigue.

But none of that will change how I treat you in the hospital, with the best care I can provide.

The High Point

I'm approaching the point in residency I've been dreading.

The point where I'm constantly fatigued. I'm so tired that I can't think about doing dishes, or helping prepare meals, or managing the boys school papers. The point where I'm away from home too much, taking overnight in-hospital call every third night. The point where I feel like I will never know enough, never be able to study enough.

I've known this time was coming. I'm not sure if knowing helps me be more prepared or if it just becomes a self-fulfilling prophecy.

During intern orientation, we are shown a graph of rates of depression during intern year. The rate in June is near zero. By January, the rate is near 75%. Everyone looks at this graph and points to the high point in January. We are then given talks about how to cope during the midpoint of the year, the increasing stress, higher expectations combined with the lack of sunshine.

I am scheduled to be on Trauma service at that point.

Although impressive and terrifying, the peak in January isn't what concerned me most about the graph. The red line we were shown never went back to baseline. The rate of depression, so low among incoming residents, so happy after completing four grueling years of medical school, never returned to zero. The lowest it got was 20%.

The funny thing is that even as I approach that January peak, and boy, can I ever feel myself rushing towards it as my confidence and ability to stay awake while standing are every tried...the funny thing is that this is still better than medical school ever was.