Memory

When it doesn’t occur in an explosion, change often happens in such small increments that we don’t notice it happening. Medical school changed me in both ways. The start of school launched me into a new world of academia. I was pushed to study more efficiently and more than I ever had. I adapted to a new lifestyle. These changes were dramatic but expected. Starting a new job, which is how I view school, is usually that way. However, looking back at my first year of medical school (so far), I changed in unexpected ways that were not obvious in the moment.

Not so long ago I was learning brain anatomy. The topic was interesting and boring at the same time. The individual pieces of information were simple, however, woven together into pathways and functional groups these bits of the brain were quite complex and somewhat indeterminate. As I was considering several parts of the brain involved in forming memories, I found my mind wandering beyond the curriculum. Memory is an interesting thing.

My sister has always had a good memory. She can read a document 3 times and recite in perfectly; this worked well during her acting career. She always remembers things I’ve long forgotten from when we were kids. My memory has never been like hers. As a high school student, I thought that memory was an innate quality. I thought memory wasn’t something that could be trained and changed. I took that belief to college where I worked hard. I’ve always known that most things can be achieved if I work hard enough. Since college and until now, I haven’t thought too much about memory.

Medical school has made me reconsider memory. As I thought about the corticospinal pathway carrying motor signals from the brain and brainstem to the body and the anterolateral pathway carrying temperature and pain signals in a chain of neurons up to the brain, I realized that these things were complicated. But, they didn’t seem as complicated as they would have back in August when I started medical school.

These days, I find myself reading words I can’t pronounce and remembering them. I find myself reading dense documents about the presentation of a disease or the features of a drug and remembering more than I did when I read comparable materials in October.

As I was studying what parts of the brain are responsible for different aspects of memory—working, long-term, emotional—I realized that I have trained my memory since starting medical school. And, while my brain’s approach to remembering is still different from that of my sister’s, memory formation is dynamic. The brain is plastic just like the rest of life. Considering this, I’m curious to see how much my brain will change by the time I reach the end of medical school. Residency. And beyond. 

But, first, time to finish the last 4 weeks of my first year of medical school – hours that will be spent learning many aspects of the central nervous system beyond memory and brain structure.

Burnout

Alarm. Study. Class. Study. Eat. Study. Bed. Alarm. Study. Class. Workout. Study. Study. Bed. Alarm…Repeat. Repeat. Repeat. Sometime in the future substitute work for class and study.

My sister and I have a term for the life leading up to burnout. We call it living like a robot. It’s a life where work and/or school consumes you and sometimes you fit in sleep and things that make you happy. Most of the time in the robot life you simply work and wish you were sleeping.

The robot life is unavoidable sometimes if you have hard goals. I have always justified it by knowing when it will end. I’ve had several bouts of that life with years of rest between. Most of my undergrad I was a robot. My two years of post-bacc, pre-med studies plus all the work piled on top were some of the worst years I’ve known. Medical school is the first time I’ve not worked as I studied since middle school. It’s nice to have one job, just medical school. But, honestly, it’s still hard.

Medicine is cursed with a heavy dose of the robot life. This is partly because physicians have peoples’ lives in their hands, so expectations are high. It is partly because the type of people who become physicians are A types and have high personal goals. It is partly because health is ubiquitous and illness unavoidable. As humans, our ability to reach our full potential is partially determined by our health. If we are in pain or ill, we can’t do all the things we would if we felt well.

Medical school and then working as a doctor are challenging because the hours can be long. They’re also draining because the work is complicated and requires focus and lots of puzzling through piles of clues to find the best answer. The pressure is high because the puzzle directly impacts a human’s life. And depending on the gravity of the puzzle, the answer might impact a whole family.

Time and intellectual challenge aren’t all that makes medicine difficult. It’s a team sport, so office politics and business relationships come into play. But even teamwork isn’t the hardest part of medicine. Medicine is an emotional job. People who come to us as patients die. They lose function. They lose the ability to lead the lives they’ve always led. There are many happy outcomes, but not all patients’ stories end with joy. The sad outcomes add up as time goes on.

My time in healthcare as an EMT showed me that no individual patient impacted me unbearably. However, there are days when I feel the weight of all the patients I’ve helped. For example, I felt heavy after the last CODE I worked before I left the ED for medical school. A CODE is when you do CPR, shock, ventilate, and take other measures to try to revive a person whose heart has stopped.

That night I closed the curtain on a 30-something-year old with a wedding ring who hadn’t been identified yet. He was dead before he arrived, but we did CPR anyway. I was one of the last to leave his room. I never leave a dead patient before ensuring they’re presentable for family. CODEs are messy. If the family isn’t there to see us work, I see no need for them to experience the mess. I knew sometime in the night his partner would learn he was dead.

Tucking in that patient right before I ended my shift was hard. The death rested on top of the morning I walked into the ED to find teens on the phone crying. They, the teens, were calling their family to tell them their mother and uncle had died. Odd to have children deliver news most adults barely can. The sadness those teens felt added to the day I cleaned two CODEd patients back-to-back so they wouldn’t be bloody and dirty when their family arrived to say goodbye. After tucking in the second of these, I walked out of the room to find a visitor approaching. I interceded and joined her, but only upon entering the room did I realize she, the daughter, didn’t know her mother was already dead.

The sad endings add up. But, so do the good journeys and happy endings. The patients who turn our days around by sharing the most amazing stories or giving advice that is perfectly wise. Days in healthcare are brightened by visitors who show raw love toward someone stuck in a hospital bed. I’ve seen true love hiding in ED rooms on multiple occasions. It was working with old couples in the ED that showed me how I’d like to age.

It’s no surprise between the stress of the job and the rigor of the schedule that doctors and medical students burn out. However, knowing our challenges gives us the knowledge we need to persevere. Even within the field of medicine there are many decisions we can make to suit our goals. It begins with specialty and is followed by location and type of hospital. We have the information we need to know how a specialty, location, specific hospital, and extra projects we take on will impact our life or encroach on free time. We can decide, within the scope of meeting our obligations, when we wish to do extra and when we wish to do the minimum. Most importantly, we know that no state is permanent unless we let it be. 

I think at the root of avoiding burnout is being honest with ourselves and checking in with ourselves. There are stretches of school and work that must be survived. The robot life must be lived sometimes. But, amidst the madness we must decide when it will end. We can choose to rein things in when needed. We can choose to prioritize family or life outside work. Of course, to do this, we must know ourselves and what makes us happy. Once we know where we find happiness we can fight for it as fiercely as we fight for our patients. In the end, if we are not well, we can’t help anyone else at the level we can when we are in good health.

Today I’m Grateful

The past few months have a been a tornado. I’m 3 weeks out from finishing my first semester of medical school. What has “med school” meant for me so far? 4 hours or more of studying a day no matter how many hours I spend in class. Showering the formaldehyde smell out of my hair because I’ve spent hours in the cadaver lab dissecting or practicing structure identification. Discussing the ethics of assisted suicide, abortion, and patient consent. Considering how to evaluate research. Practicing physical exams and asking patients about their health.

But, even on days before an exam, when I’m exhausted and uncertain I know half of what I should, I’m excited to be doing what I do. I know how to feel a heartbeat through someone’s skin. I know how to watch a heart contracting using an ultrasound machine. I’ve held human hearts. I’ve explored their chambers and vessels. I know the path blood takes to and from the heart. I know what makes the heart beat. As the days pass, I know more and more about what makes human bodies function, how the body can break, and what we can do to fix it. For this intimate knowledge of life, I’m grateful.

These past weeks and months haven’t only been studying, despite how it feels at times. I’ve spent time with family. I’ve hiked many a mountain in both the sun, rain, light, and dark. I’ve eaten cake on mountain tops, carved jack-o-lanterns, and shared many a meal and snack with friends. I’ve walked up and down the hill from home to school while chatting with kindred spirits.

Friends new and old along with family aren’t all I’m grateful for this season. I also have a lovely home with a roommate with an eye for creating comfortable spaces where I can sip my mate peacefully. And, I have a partner who enjoys pie as much as I do. Helps keep life in order. Tells me my hair looks beautiful even when it’s greasy and fizzy (who knew hair could be both those things at the same time) and cooks me dinner so I can study.

I feel lucky this season. And, I’m grateful to have a few moments to soak in just how kind life can be. I hope your Thanksgiving is spent with people you care about or, at least, surrounded by tasty food. After all, the stomach feeds the heart. 

Last Day in the Emergency Department (for Now)

July 25 was my last shift at the emergency department (ED) as an EMT. It’s hard to believe in a few short weeks I’ll start medical school, and my time as an emergency medical technician will be filed away as part of history. Becoming an EMT challenged me and made me face personal fears. The uncertainty I had when I first embarked seems comical now that I have those years of patient care under my belt.

I couldn’t be more excited (and nervous) to start training to be a medical doctor. But, leaving the ED was bitter-sweet. I’ll miss my crew—the ED is filled with dedicated people focused on improving their patients’ lives. If every team I work on is like mine was in the ED, then my career as a doctor will pass quickly and happily. What also makes me sad to leave the job and start school is that I won’t have many opportunities to work directly with patients for a few years. The first two years of medical school emphasize learning all the facts you need to know to be a doctor and, in years 3 and 4, you start applying that knowledge in real health care settings. I got into healthcare because I want to help people. I find learning thrilling, but my motivation comes from the practical applications of the knowledge I gain. I can’t wait until I am back in the trenches seeing patients and trying to solve real health mysteries.

I became an EMT because it was the fastest certification that would allow me to work directly with patients in a way that required me to assess their signs and symptoms and then make clinical judgements. Becoming a doctor will give me a lot more knowledge and a much bigger toolkit to help my patients than I have now. But no matter where I end up in healthcare, I won’t forget from where I came. As an EMT, I learned to identify a sick human in a split second. I learned how to ask for people’s health stories and focus on the information I needed to help them. I saw firsthand how excellent patient outcomes are the result of teamwork (between all players not just the docs) and that poor communication leads to worse results. I hope these lessons stay fresh as I cram new ones into my brain.

Making It

The past couple of weeks have been challenging in the same way my first weeks after graduating high school and college or swearing out of the Peace Corps were. Starting a new chapter  because you achieved a goal after hours, days, months, and years fighting for it forces reflection as you hit the reset button. My distilled thought process follows this line, “Well, you’re here, now what?”

When I finished high school and college I was proud, but still unsure of who I’d be or what I wanted to do with my life. When I finished the Peace Corps, I was petrified that I wouldn’t be capable of learning science, getting into medical school, and (ultimately) becoming a doctor. There was so much uncertainty accompanying those transitions. My confidence, not without nervousness, as I get ready to embark on the next phase of the #DoctorhoodQuest is a new feeling for me. Finishing medical school is NOT a guarantee, nothing in life is a guarantee. However, the trust I have in myself to weather the quest unless derailed by forces beyond my control is new and I like it.

I never thought I’d get here, but as I race towards 30 I feel like I know who I am, the values I’ll fight for, and the battles I always avoid. For the first time in the midst of a major professional transition, I’ve focused on setting up all other aspects of my life more than the transition itself. The questions I’ve asked myself include: What do I want my living situation to be like in this phase? Who do I need to visit before school starts? What are my priorities when I have free time? What do I want my work-life balance to look like? What’s missing?

I’ve taken this calm before the storm to bask in the reality that I’m happy. I’ve taken time to think about the things that make me happier and do them or prioritize them. For the first time, I feel 100% content with my professional standing. For once, I have time to focus on every aspect of life. For once, I have a schedule and geographic location that allows me to go hiking multiple times a week and to walk, bike, and run every day if I want.

I find myself asking often, “what’s missing?” Things are always missing, but right now the answer to that question doesn’t include anything major. I have many goals that are years away from being realized. There are things I’d like to add to my life that aren’t even a spark yet. But, for once, I can say “I’ve made it.” I’ve made it to a point where I believe it when I say that life is pretty grand. These days before I take my quest for knowledge to a level I didn’t know existed when I graduated high school and college, I’m enjoying the sunny days and the starry nights of a fresh Vermont summer. I’ve made it to a happy phase and I’m grateful for that.

5 Years Later – Quiet Moments

About five years ago I moved to Paraguay. I wasn’t sure what would come of a continental move, but I was ready for a challenge and I wanted a break from the American rat race for a few years. I had high hopes but no clue what to expect. I’d first learned of the Peace Corps when I was in 7th grade and known since then that I needed to do it.

I’m sure I’ve said this somewhere in a pervious post, but living in Paraguay and among Paraguayans changed me. People are always changing, but there are life experiences that expedite change—the Peace Corps (and living abroad for a few years) is one of them.

Living in Paraguay changed my self identity, my daily priorities, and the way I thought and saw the world. My experiences in Paraguay fine-tuned my values. Being a foreigner, the only white girl, the only American, the lunatic who liked to go for runs and hour-plus walks, the veggie addict, the advocate for sex ed and separation from abusive partners, the outspoken supporter of love regardless of gender mix, the not catholic, the woman with unpainted nails, the single one, the over 25 and still childless woman, the one who wouldn’t wear short shorts and small shirts, the female who refused to dance in heels, the one who disliked pork and large amounts of meat…being the odd one in the fish bowl forced me to think about the battles I wanted to pick and those I’d leave for never.

Of all the things I learned, what stays with me is the internal calm and confidence the women in Paraguay shared with me. Life is ridiculous most of the time, but Paraguayan women have a natural grace and pride that is humble and unwavering. I certainly didn’t luck out and get their grace, but what I did learn is that we (humans) are better and happier when we make time for quiet moments. I’ve been thinking about the secret to Paraguayans’ love of life and happiness for these 5 years, and I’m pretty sure it comes down to making time to be still. Everyone has their way of doing this, but mine has come to be drinking mate. I learned to drink mate in Paraguay.

Mate is a tea-like drink made from yerba mate. It’s loose-leaf tea that you put in a cup. In the cup is a metal straw with a filter at the end. You pour hot water over the leaves and drink through the straw almost immediately. With a little practice your lips get used to the hot straw and you don’t burn your tongue on the hot water.

Yerba mate has some caffeine in it, but I mix the yerba mate with so many other herbs (peppermint, hibiscus, lemon grass…) that it hardly has any. I don’t drink it for the energy boost. For me, mate provides moments to reflect. For me, it’s the symbol of my time in Paraguay, personal growth, and the people I care about. Mate is usually a shared drink. Since returning to the US I always drink mate alone (because people here don’t drink it), but I still think of the Peace Corps volunteers and the Paraguayans who shared it with me. I also think of the other people in my life, currently and in the past, who are shaping my world even if they’ve never sipped mate.

Five years later I still drink mate because I learned happiness is in the still moments. I learned that people are where joy comes from and that I am the best human I can be when there is time for mate in my life.

As I write this my mind is quiet, but deep down the excitement and nerves of starting medical school this August are bubbling. I’m about to embark on another journey like none I’ve done before—the expedition of learning and mastering the ways of the human body. The challenge of becoming a medical doctor. But, as hard as medical school is, I know living in Paraguay was harder and I already did that. And though there will be days in medical school when I’ll skip mate, I know that it’ll be quiet moments drinking mate that will propel me through the countless exams, the high stress of learning more than seems possible, the life-or-death decisions, and the sadness of seeing people suffering. Everyone, I think, has their grounding mechanism. It turns out that mine is a dried herb I buy 6 kilograms at a time and often sip before most other people’s morning alarms have started snoozing.

Finding the Path

We all have bad days. The problem with having a bad day and working in healthcare is that it’s unacceptable for your mood to affect the quality of your care and people are sick every day. The trouble with healthcare on a bad day is that healthcare requires hundreds of human interactions within a shift. Hundreds of moments where patience is required, where you must do small tasks that are annoying and big tasks that are important, and all the tasks between that together help people heal. You notice everything a little more on a bad day. So how do you get through it?

Not so long ago, my shift landed on a bad day. But, there was a patient who turned the shift around for me. He told me how he raised his sons. He was a single father. He had a path he wanted them to go on and he thought his job was to lift them back up to that path when they fell rather than push them down. That’s what he did and he was proud of them. He told me he was lucky.

I think I’d like to approach bad days like this father approached his sons. A bad day is a fall from the right path. It just takes some nudging to get back on track again.

The benefits of working in healthcare on a bad day are the kind, wise patients you’ll likely encounter. They’ll set things right, even though you’re the one that’s supposed to be curing, if you listen to them.

Empathy

One busy day in the emergency department (ED) we had a psych patient in a hallway bed. I don’t remember if he was visiting us to stay safe while struggling with suicidal thoughts or if he had come to the ED for some other mental health reason. We try to put patients with mental health complaints in a room as soon as possible, but sometimes the hallway is all we can do for a few hours. This patient fled even though his condition required him to stay in the hospital. He outran hospital security and escaped hospital grounds. Police brought him back to the ED.

I’d seen him sitting on a stretcher in the hall before he fled, staring into space calmly. When the police brought him back, he was slumped forward in a wheelchair with blood running down his shins. He hadn’t had those scrapes before he fled and they caught him. I knew they must have tackled him, but I couldn’t say because I wasn’t there. Later, I’d rinse those scrapes and the ones on his torso, arms, and hands. Nothing too deep, but the iron smell of blood was strong. The patient was NOT angry about the scrapes; he just didn’t want his mother to see him until he was clean again. I couldn’t help thinking that sometimes the price seems steep for safety and medical treatment.

It was a terrible feeling to see someone start in the ED without a scape and then end up with many before their stay was done. I was shaken. I spoke to a coworker about it. I like to discuss things during shift so everything that happened stays at the hospital when I leave. My coworker listened to me carefully and acknowledged the challenging aspects of the situation. It’s always hard to see someone’s mind betray them and, in their worst moments, need restraint from medical staff or police. It’s hard knowing that the violence is part of the route to recovery. My coworker said, “It’s okay to be bothered. If you weren’t, then you’d know it was time to leave this job. When you don’t feel empathy anymore, it’s time to change careers.”  

Empathy is a harsh beast. I believe most of us are able to ignore empathy at least some of the time because it is too much to always feel our emotions and, also, those of someone else. Which has led me to ask several questions about empathy’s nature. How is empathy turned on and off? Is there a time when empathy is out of place? Is it right to push empathy aside to protect oneself? Why are some people more empathetic than others? What does being very empathetic say about a person? Can empathy be taught and untaught?

The Sunny Side

Last week I flew to Chicago for my last (most likely) medical school interview. I had the window seat on the plane and, surprisingly, wasn’t sleeping as we approached Chicago. I was excited to spend 24 hours in the city and get a feel for a place I hardly knew. I gazed out the window as we started our decent.

Before we decreased our altitude, we zipped along above the clouds, through a bright blue sky with sparkling sun. A thick layer of clouds was below us. The view of bright blue above white divided by shining sun rays conjured images of every version of “seeing the light” imaginable—end of the tunnel, heaven’s gates, nirvana…to name a few. The clearness and stark lines between the blue and white were beautiful.

Slowly, the plane’s path dipped so that we began to approach the clouds. We must have been far above them because it took us a while before we got close to the wall of white. I knew the clouds were a penetrable, gaseous/small particle entities, but they looked solid and impassable. We approached them quickly, and soon the sunny view of blue was obscured and the windows were masked in white. We were in the middle of the clouds and there was nothing to see.

Our journey continued rapidly and, in no time, we were below the clouds, a snowy and gray scene was visible below us. The sun seemed to have vanished, leaving a stark winter city scene. There were no leaves on the trees and the buildings added to the gray of the air between the land and the clouds. It looked cold and brooding. If I hadn’t just observed the sunny blue above I wouldn’t have known it could exist in the same place as we now were.

I smiled as I stared at the houses and streets, a bird’s eye view of the cityscape. I guess it’s just a matter of knowing where to look to find the sun. I held the vision of sunlight within me as I caught the train from the airport to where I’d spend the night before my interview and school tour. I’d been nervous before starting my trip, but I wasn’t anymore. I felt lucky.

Closing 2018, Opening 2019

If I had to pick one word for 2018 it would be “success.” I finally got a job taking care of patients, this officially marked my transition from a communications career to a health care one. With each passing day, I grow more certain that I’m headed in the right career direction. I finished my pre-med requirements, took the MCAT, applied to medical school, and got into several medical schools. I made some awesome new friends and visited some of the best long-term ones. The farthest friend visit was to my beloved Paraguay (I also visited friends in DC and Atlanta).   

This New Year’s finds me at a crossroads. In the coming months, I will decide where I will go to medical school. I feel incredibly lucky to have options, especially because I only applied to schools about which I am excited. The cost of school and if I should move to a new state weigh heavily on me. Starting the next chapter in the doctorhood quests is simultaneously overwhelmingly exciting and completely petrifying. But, change and moving are nothing unusual for me.

Earlier this year, I wrote about “name the fear and conquer it” as my general approach to life. A huge part of that is identifying when I’ve fallen into a mindless routine and, then, breaking that routine. I’m the type who as soon as they learn something new looks for how to become better and how to expand my knowledge. I think this trait will serve me well in medical school. It’s served me well in everything else I’ve tackled. But, as I think about these traits and the exciting goals that are coming to fruition this year, I find myself thinking that my biggest New Year’s resolutions have little to do with my career ambitions and a lot to do with the rest of my life.

I have high expectations and hopes for myself as I begin medical school, but I know I will put my best self forward in pursuing those regardless of my New Year’s reflection. Therefore, as we slide out of 2018, my New Year’s resolutions are to focus more on relationships and adventure. In that vein, here are my top 5 resolutions:

  1. Do a better job of staying in touch with old friends, family, and contacts even in the midst of school mayhem. This may include taking more time to visit friends who live far away, writing letters, texting, emailing, or social media-ing.
  2. Focus on developing new friendships. The challenge for me is always ensuring I leave enough time to spend with friends even when school work crescendos.
  3. Travel outside of the country, to a new place, at least once in 2019.
  4. Travel or visit somewhere new (even if it’s a day/partial day trip) at least once a month.
  5. Join some initiatives/groups that don’t directly relate to my budding career in medicine. Ideas I’ve pondered before or relate to interests I have include: joining a gym (I currently workout at home), ballroom dance classes/club, hiking club, book club (currently in one), or writers’ group; taking a yoga or martial arts class; becoming a youth mentor; and/or joining a choir.

Besides the New Year’s resolutions, I plan to continue my daily struggle to smile more, see the best in people, and be the kindest person I can be. I wish you the best of luck in 2019—I’ll be taking it one day, one week, and one month at a time. Happy New Year!