WOW.

It is time for me to gear up. I'll will admit- my third year of med school I have been a complete slacker. I barely read, I rarely did any work outside of my rotations. I figured I could cram at the end and be fine, but after getting my shelf grades back, I'm starting to doubt this theory. Unfortunately, it's too late for a do-over, so from here on out I really have to get it together! I am working through usmle world for my Step 2 CK, and also plan on reading step 2 secrets and First Aid for Step 2... I might have to push back my exam, bc my percentages are dismal at this point. It just might take longer than 3 weeks to get to where I need to be. But either way, I need to set a bedtime for myself and be sure to get out of the bed early and get my studying started before NOON.

People say to not worry about step 2, that it's "all downhill" after step 1 and third year, but my percentages right now don't even correlate to PASSING the real thing. I happen to really, really hate pharmacology, and there seems to be a lot more of it on this test. UGGH.

I need to get it behind me so that I can
1. actually do some rotations, which will enable me to
2. actually make a decision about my specialty choice (I know, I'm still wavering, today it's ob/gyn- give me the OR over writing scripts-!)
3. get recs
4. along with (REWIND) getting my VSAS pile of crap together so I can actually
5. see my husband who is living 3 hours away and also
6. most importantly network in aforementioned city and impress attendings (I swear, this sh*t never ends)
because the ultimate goal is to
7. actually match in the same place. :boggled:

can you tell I'm stressed out?

coffeeandtea

ps. and I'm on a diet. my stomach feels like my brain- :censored:

I just have to write to say that I am thoroughly enjoying myself during my time off. technically I'm not "off" because I'm studying for step 2 ck, but I am spending the vast majority of my days in an empty house, in my jammies, studying at my leisure. It's not the studying that is making it so enjoyable for me, it's the fact that I've been cooking!! :yes:

Cooking is something I actually love to do, but rarely find the time. In med school my release has always been in the kitchen, making something with a 100 ingredients while I drink wine and blare music. It's my favorite past-time. So, I haven't cooked THAT much, but it seems like the more I cook, the more ideas I have and the more I want to cook. I have been living off of my husband's idea of eating for the past 2 years, and it's resulted in a 25 pound weight gain and probably some mild vitamin deficiences, bc he could literally live off of bread and eggs. and cheese. and sour cream. yep, that's about all he requires. But with us in two different places, I get to buy whatever groceries my heart desires (lots of fruits and veggies) and cook!

anywhoo, so I'm not going back. I'm going to get this weight off for good! the thing is, I've been so excited about how I'm actually enjoying this diet. Today I made a 3 egg-white omelet with peppers/onions, a little cheese, and ham, with salsa+hot sauce, and it was GOOOD. yum. yesterday I had an egg white mixture with Ranch beans and jalepenos on a whole weat tortilla and it was good too. plus I've been making yummy salads. and I love this quick snack- black cherry jello+pineapple+pineapple juice from one can plus whatever it calls for in whatever - juice. It is really refreshing and with some cool whip on it is a nice dessert that hits the spot.

anyway, I finally went to the gym yesterday too! I worked out for one hour, and it was really tough, bc I am so out of shape.

Anyway, all of this normal living I've been doing is so restorative. It makes me never want to go back to the grind of medical school. I was thinking today, maybe I should do something like family medicine or pathology, and just enjoy living my life. I feel like I have to literally recuperate from my third year of medical school. It was a beat down! I love ob/gyn, but I wonder if I'll never get to cook, never get to go to the gym, sleep in late, do all of the things that make me feel more like a normal human being.

Decisions, decisions.

coffeeandtea

I tried some stuff on tofu today. It's in the oven right now, so it might not be tasty, we'll see.

tsp oil
2 tbsp wasabi ginger finishing sauce (bittersweet herb farm)
garlic salt
cayenne
tsp white wine vinegar
tbsp brown sugar

guess we'll see!

so I'm back to saying I want to do ob/gyn. My mother is very unhappy about this. I can see why- I've kind of set myself up for it. I tell her it's so family un-friendly, and give all the reasons I wouldn't want to do it, then I completely flip my stance. the truth is, I have no idea if it'd be too much. I guess the main problem that I have is I'm very limited in my options, and of those options, ob seems like the most enjoyable.

I don't want to do general surgery, esp at hubbie's program, and especially after what he's told me about it, from his experience there.

I don't want to do peds, bc frankly I don't enjoy rounding or taking care of medical programs. and I enjoy kids, but I think I'm a "small doses" type person. I don't know if I could handle all kids all day every day. Plus, I didn't really love my peds rotation. so why settle for working hard and less money if your heart's not just set on it?

pathology- I'm not sure I want to ostracize myself from patients, always and forever. It would be great for time off, better schedule, but I don't think I'm analytical or antisocial enough to enjoy it. plus I don't really like microscopes. heh.

family medicine- might actually be a pretty good fit, considering I generally like people, and I'm good with people, and I like taking care of people. But the program in city where hubbie resides has a notoriously bad FM program.

ER or anesthesia- sort of the default if you like OR and/or procedures and want to make a decent income while maintaining a semi-normal life. unfortunately, hubbie's city has neither.

That's right, NO ER OR ANESTHESIOLOGY residencies. at all. in the entire city. So if anyone was wondering why I didn't consider these, since I like procedures/want a family/etc. that's why.

So, that leaves ob/gyn.

I mean, there are lots of reasons why I really like it.
- I like women's health.
- I like procedures.
- I like clinic.
- I like the OR, a lot, actually.
- I enjoy delivering babies.
- I like the variety.

you know, all of the reasons anyone going into ob likes it. I just don't like the hours. and I'm going to miss having time to cook, bc I really love cooking. I don't like to be rushed, and I don't like life to be too busy/hectic to enjoy hobbies. but after residency, people say it's semi-flexible. I know I'll be taking call forever, but one in seven is pretty nice, and maybe even the laborist positions will be available by then. I sure hope so.

so I'm treading carefully, not optimistically, when it comes to this decision. But I have to make one, I am a fourth year and it's just time, past time, for me to decide on this.

now, if I follow through with my commitment to it, rotate through it, and hate it, well then, it's back to the drawing board.

coffeeandtea

well, big news.

after a weekend of hard self-reflection, lots of racking my brain, and a two hour conversation with a doctor/mother in a dual physician marriage, who has known me for the last three years, and knows my situation, I have made a big decision.

I am putting husband and future family as #1.

For me, that means giving my "best self" to my home, my husband, my family. This doctor is on faculty, she actually interviewed me(!) in my medical school admissions interview. She has known me since those early days, four years ago, when I was sweating bullets hoping to get in. We talked when I was a newly wed and having a hard time. We talked after my brother died. She has written me scripts for antidepressants and birth control. I highly value her opinion. I knew what she would say today- she would echo the same thoughts I've been thinking all along, but ESPECIALLY loud and clear this past weekend.

She said that her kids and her 24 year marriage has been the biggest joy and the thing she is proudest of, even though she is a doctor. She said that I am the type of woman who is going to put my kids first, who isn't going to want to be "my best" for the hospital. I'm going to want to have fun with my kids, not dragging myself home exhausted every night.

she recommended ER, path, family med, or peds.

There isn't an ER program in hubbie's city, the closest is two hours away. So I will try to rotate two hours away, and see what I think. I think I would be *gung ho* ER if there was a program in hubbie's city. I hate the thought of doing four years long distance, but long term, it would be the most flexible. plus, I like procedures, the variety, working nights, working hard when I'm at work, all of the other things that attracts people to ER. So we shall see. If long distance would benefit us the most long term, it might be worth the two hour commute. After all, hubbie is doing a general surgery residency- no matter where I'm located, it will be a stretch to see each other.

Family med is a consideration, but the program in hubbie's city isn't the best. Actually, I think it's pretty bad. But I might get decent training there, anyway. Or I could try for a few other programs- one is one and a half hours away, a few others are two hours away... both of those are solid. Same concerns as the ER situation with distance... kind of worried that my job might get taken over by nurse practitioners, is this a stupid concern? also, if I'm going to do medicine, I wonder if I should just do internal med at hubbie's school. although I didn't really enjoy internal med as much as family med. I like clinics more than hospital medicine, I think.

peds is debatable. I'm just undecided if I want to do all kids, all the time. I'm doing a rotation next month, so it's hopefully going to make up my mind for me. If I like it, it'll be easy for me, bc the program in hubbie's city is spectacular!

I'm considering a path rotation, but with the current dismal market in path, I'm not so sure about it. I'm going to need LOTS of flexibility bc hubbie wants to do academic surgery (most likely) which will involve a fellowship, which will probably involve moving. So path is a potential option- not sure...

anyway, just getting out my thoughts. I feel relieved though, having ruled out ob/gyn FINALLY. I think I just needed to really consider it to realize that for me, it is not worth it. I nearly had palpitations just thinking about doing it. It was nearly nervous breakdown level anxiety about it.

well, any advice would be helpful, if anyone has anything to add/consider. Just trying to make a wise decision...

coffeeandtea

So here are the options...

1. pediatrics
+ solid program in DH's city, where my home is
+ can be family friendly after residency, meaning no nights, no weekends, limited call
+ option to work part-time
+ option to subspecialize, including ER track
+ considered the "go to" person, specialized but still general
+ people are friendly
+ pregnancy in residency is a possibility
+ call isn't that terrible q5 x 4 mo after intern yr

- limited to working with just kids
- if you don't like general outpt peds, could be very hard to find a job
- pay kinda sucks
- still have a decent amount of call, isn't a "cushy" residency


2. Family Medicine
+ option to do anything you want- women's health, see kids, palliative care, etc.
+ some procedures, though not a lot
+ residency is nice, home call after intern year
+ jobs are EVERYWHERE so I would be MOBILE
+ option to work part-time
+ compensation better than peds in the southeast
+ again, residency gives time to moonlight, free food, super nice
+ ppl are generally laid back
+ no nights, weekends, holidays if you want

- program in DH city sucks
- other programs within 1-2 hours, but would have to live away from home
- not a lot of subspecialty options
- no baby in residency with long distance marriage


3. ER
+ residency mainly shift work with little call
+ a good bit of procedures
+ part-time work after residency an option
+ pay is AWESOME
+ jobs are abundant
+ equipped to treat all ages, in acute situations
+ peds ER is an option (and it's 5 yrs vs peds route which is 6)

+/- fast paced working environment

- long distance from DH- 2 hours minimum
- increased mortality risk working all those night shifts
- could get really tired of working holidays, nights, weekends
- scheduling could be a problem with lots of young kids who thrive on a schedule
- no pregnancy in residency due to distance
- pregnant in the ER working 12 hr shifts with no time to pee???


Thoughts anyone?

Had a dream that I took a pregnancy test, but you had to interpret the results by this really complicated chart that looks exactly like the HepB serology chart.

I was trying to figure out which line meant I was preggo. Which in the dream, I was, and it took me a really long time to figure it out.

WEEEEIIIRD.

pretty obvious as far as dream interpretation though! :laughing:

well, back to qbank. it's been raining outside and I love it!

coffeeandtea

Well today seals the deal.

I am absolutely completely NUTS.

Crazy. Lost it.

So. today was my dean's letter meeting. had a last minute change of heart and another breast surgery relapse. that's what I'm calling them now. Lapses.

So what do I do? Disregard my step cs which is schedule for sept 10. Disregard the fact that I BEGGED to be added to the september ER schedule. Disregarded all of the soul searching and hang wringing I've been doing the past few months to figure out what's best for me.

And undue everything.

I dropped ER next month to do general surgery. almost immediately I felt dizzy and sick and bad about it. Then I realized that the step 2 cs is booked solid for MONTHS and I have it on the tenth. And Good Lord in Heaven if I didn't have the PERFECT schedule to take this test when I was still signed up for ER. The day of is off- sept 10- plus the THREE days before it- OFF.

I am a whack job.

Sorry for all of these "crazy" terms thrown out there. But I am realizing that there is something wrong with me. This indecision is becoming down right detrimental. So now I have to march back over to ER tomorrow and see if I can "undue" this.

This all culminated (the realizations, that is) when I finally showed up for my dean's meeting at 3 pm today. I had already completely jacked up my schedule. then, in spite of my best efforts, I could not even act committed to doing general surgery. This was not with the dean- it was with a staff member who is also in a dual physician marriage. I went from walking in and being like "surgery it is!" to telling her I really want, more than anything, for my marriage and family to succeed. more than my career. more than residency. by the end of it she was saying she'd pray for me, to really think about my husband, she actually said, "he's going to be a surgeon and there's pirhanas out there!"

by the end of the meeting, I had decided that I really belong in a primary care field. in fact, she pulled out all of the comments made about me over the M3 year, and every single specialty had *awesome* things to say about me except surgery.

especially peds, family, internal med, and ob. So like I said, primary care.

I have a great smile, I love people, people love me, I want a huge happy family and want to work part time and have hobbies. I want to start having kids before 30. maybe even get started in residency.

so why can't I get it through my thick skull that primary care is what I should do with my life?!?!

I'm beyond tired of doing this to myself with all of this second guessing. I'm tired of it. so tired. I'm ready to just commit to something, have it out of my hands. I just don't trust myself anymore.

hopefully they'll let me have my amazingly perfectly scheduled ER rotation back for next month...

I am miserable.

I give up.

After another fight with my husband, I have decided we are incapable of communicating with one another, and it will only get worse now that he is maximally stressed out and sleep deprived as a surgery intern.

I have concluded that whether I go to hometown to be with him, or do residency somewhere else, we are most likely doomed to fail, given our inability to communicate, our practically opposite natures/temperments/habits/future ambitions, and so ultimately, it doesn't even matter what I choose.

though when it comes to choosing anything for myself, I give up. I regret coming to medical school every day. I regret the life I have made for myself, I regret putting all of my hopes and dreams and time and energy and money into this singular pursuit, only to find that at the end of it, I either want to a) just crawl in a hole and hide or b) somehow undergo metamorphosis and become a confident, strong willed, fatigue resistant human being and just do surgery already.

unfortunately I feel trapped with neither of these options really being practical. I love sleep. I love sleep too much to go without it for years, even if the only meaning that I can derive from my existence right now is the hope to someday hold a scalpel.

what a shallow, hollow existence I feel I have right now, that a scalpel would be the only true device to infuse my life with meaning. truthfully, the marriage is a failure. I threaten to leave him, he remembers, until finally he threatens to do the same. I know that as long as we're together I'll be in his shadow.

I wish I could just escape my life. I am here, in my fourth year, and it is just unraveling right before my eyes. I have no time. I am officially out of time. If I don't make decisions, make decisions, make the g*d d*m decisions NOW for chrissake it will be too late.

and then what? (the psychologist likes to say, when speaking to a panic-anxiety stricken patient)

It all boils down to complete conceit. I envisioned being powerful. I believed medicine was a calling that would make my life larger than life, make me larger than life, somehow evaporate my problems.

but no.

I am out of solutions.
I am out of creative ideas.
I am out of motivation.

thankfully, I have been drinking wine, so maybe the morning will bring just a tinge of optimism.

I am tired, so tired, of being misunderstood by my husband. I am tired of our arguments. I somehow thought I would be gaining my biggest fan in this marital situation. But somehow, I just feel completely unimportant and alone.

coffeeandtea.

well, I had the completely meltdown today, that has been brewing for a number of months.
started crying and couldn't stop, in basically every bathroom in the school. finally the secretary drug me into her office, locked the door behind her, gave me a diet coke, and passed the tissues.

and then I cried, and cried, and cried some more.

and I actually feel a little better, even though my face hurts. :boggled:

coffeeandtea

The dreaded day- September 1

Let me just say at this very point at time, while I remember the feeling WELL- before the feeling wears off, exactly what today was like. For that hour that I was awake this morning, and forcing myself to get out of bed and head to the hospital to do surgery, again, completely by my own volition- for that HOUR- I felt absolutely disgustingly overwhelmingly sick, breathless, like the world was spinning too fast, like my head was going to explode, like my heart was going to stop or pound through my chest, like my stomach was spilling acid into my intestinal cavity, oh, you know, all of those horrible feelings and more. I felt like I couldn't catch my breath. It was a panic attack literally. If it had been anything less I would have marched my way up to the lounge and done it. But the feeling was absolutely unbearable and unrelenting. It would be like ignoring a ruptured appendix. So just for future reference, if I need a reminder. I walked away knowing because I couldn't bear the thought of doing surgery. It ultimately felt like a small death, like the walls of my life would be closing in, shutting out so many things that I so desperately desire- to keep my marriage in tact, to have time and energy to love my husband and my family, and to go to church and keep God top priority in my life, to have a family and watch them grow. nurture them and love them and have time to have dinner on the table most nights.

which is why I'm doing ER. I can have dinner on the table EVERY NIGHT if I do ER, once I'm done with residency. Even when I'm working night shift, I can have it on the table. Not that this is a major point. Because what I really look forward to is pool days with kiddos. splashing around on ENTIRE days off, taking pictures of kids, with all of their friends over. If anything, it just makes me sad that I might be doing all of this fun stuff and husband might be too busy to participate.

So that brings me to this month. Because it is September 1, the day I have been dreading for MONTHS. I have been dreading this month so much that I have added/dropped courses probably ten times. At least. but today, after the incident this morning, after crying all morning in bed, I made some big decisions. I dropped family medicine for the month. I dropped surgery. I dropped it all. That is what I've decided to do with this incredibly stressful month that I'm dealing with. I still have to make it count- take my Step CS, get my ERAS done, my letters written, spend some shifts in the ER to get some "face time". I absolutely have to like it. Just think- two days a week, clock in, clock out, and get a great paycheck. Push comes to shove, worse case scenario, it will land me a job that I can easily support my future family on. Job security. For ER, there are jobs everywhere. Everywhere. It is ideal for a working mother. Plus, it is fast paced, heavy on procedures, etc.

which I'm saying all of this, bc in my heart I am more than ready to commit to this, and to get on with my life. I worry terribly about distance from husband, but ultimately, it's only a drop in the bucket, and we're getting to where we need to be. And sometimes things aren't going to be ideal. Sometimes the ideal circumstance that you were hoping for just doesn't exist. Which in my case, it's time to let that fantasy go. For me, at this point in my life, in my fourth year, this far in, when I have debt to pay off, and other hopes for my future outside of medicine, I just need to swallow the bitter pill and do what I have to do.

which is what husband tells me all the time. Just do what you have to do.

And that, folks, is what it means to really be a grown up.