I had decided not to start a blog here, since Drey's got an excellent one, and we're at the same school. Then I realized that we have several differences:

1) I had my kids before I started med school.
2) I'm significantly older than Drey (I turned 30 in October) even though I look pretty young, so people think I had my boys when I was in college.
3) I'm a bit of a peds clinical research nerd. (Oh, who am I kidding, I've already got my research set up for this summer, pending funding. More on that in another post.)
4) I'm definitely in the middle of the pack academically. On a good day. (But hey, I have 3 year old kids and a grad student husband who works part time in addition to his graduate funding. I'm feeling not-so-bad about being in the middle-ish.)

and 5) I started doing our school's independent study program yesterday.

This ISP thing is pretty crazy, since it's not a great idea if all you want to do is skip lecture. (We have podcasts for that, so anyone who just didn't like getting out of bed at 8:30 does that. We even have a guy who speeds up our podcasts.)

But 38 of us have decided (well, the MD-PhD people didn't have a choice) to:
1) Learn a different curriculum
2) Forgo lectures
3) Learn from course packets and books, going to module leaders with questions
4) Schedule our own exams, given only guidelines and max dates (after a max date, apparently you get a zero)
5) Pass some NBME shelf exams at the end of the year
6) Get a pretty nice set-up in the ISP lounge/library.

We still do our physician development and patient centered medicine components with the rest of the class, but otherwise, we're on our own.

But why on earth would I do this if I don't even really have to show up to lecture anyway? Simply put, I haven't been able to get much from lectures, so for me, lectures are benign at best, counterproductive at worst. After that, I looked at how the curricula were structured, and realized I like the organization of ISP better. And the days that I haven't had to do anything but study have been the most productive and fastest-moving for me.

So, here I am. Two days in, and I'm ahead of the schedule I set for myself, which gets me finished in 80% of the recommended time. (I want breathing room for things like getting sick, kids getting sick, insanity, etc.)

I'm learning biochemistry now, and it's amazing A) how much I forgot from my undergrad biochem course, and B) how quickly it comes back. I will put in a plug right now for Lippincott's Illustrated Review. It's pretty much the perfect tool for me. I read it after my course packet and everything that was fuzzy becomes clear.

My kids are also doing really well right now. We had parent-teacher conferences last night. I was really dreading it, since at their old childcare centers they turned into "how much I hate your kid" sessions. (Okay, I'm projecting, but they did like to nitpick and bring up negative things.) But last night was wonderful. I knew that my kids had really pretty great literacy skills (they learned to read a year ago and now can read pretty much anything they have the attention span for), but I didn't know that they could count to 100. I also (and call me a bad mommy, but he never colors at home!) learned that one son is left-handed! The teachers talked about what fun my children are and what a pleasure they are to have in the class. I guess they have been adapting quite well for new 3 year olds. (Obligatory plug for Montessori schools. At least this one is perfect for busy families who need some help bringing sanity to the life of a preschooler.)

Anyway, we're home together for the next 5 days. We're going nowhere for Thanksgiving. We've been so busy with life that we just want to relax (and get my kids over their coughs). We'll cook a Thanksgiving meal together, kids involved in every step. Tomorrow we shop, Thursday we cook, Friday we get the Christmas tree. And I hold my breath and hope the kids don't beg to go to the zoo again, because we've been twice in the past week.

My Sons' Interpretation of How Santa Works (at age 3 3/4)

(I got part of the story, so I had to get to the beginning and ask "what comes next" about 30 times.)

Santa uses his sleigh to get down the chimney.
He then comes out of the chimney.
Then he is in our house.
Then he gets some cookies.
He eats the cookies.
He goes back up the chimney.
He moves on to the next house.

I love it - Santa's just in it for the cookies!

Today was probably my most "MomMD" yet.

We've just finished a unit on human development in our Patient Centered Medicine class, and it was "bring the kids in" day. There was also a "human development jeopardy" thing, too. So I brought my boys in.

They were very, very busy, very friendly, and had a great time. I brought books, paper, crayons, scissors and glue for them to keep them entertained. So, next thing you know, one son is handing out papers to most of the small group (18 people, counting me) and getting them to do various things (color, cut, glue) and asking them what they're doing.

They enjoyed playing with our facilitator's 18 month daughter, and our facilitator was bringing up significant developmental issues in all 3 kids as they came up, and how it would play out in a clinical setting. Good stuff.

I think it was also nice for my small group (that we have a lot of stuff with, so we know each other pretty well) to see me as a mom, and not just someone who talks about her kids.

One of the funniest things was that one of the "answers" was "Children have generally learned to stand on one foot and ride a tricycle by this age" and at that very moment both boys stood on one foot and one said "I like my tricycle." Everyone knew instantly that the answer was 3 years.

Of course we got back home too late to return them to school or take a nap, but that's okay. They'll go to bed early today, since they're totally worn out.

First block of tests done!

I love ISP. Having, in general, a day with at most one interruption for an hour or two, with the rest devoted to study, is my idea of academic perfection.

First, performance-wise: my biochemistry grade was my best yet in medical school, including "easy" things like biostats and epidemiology. My genetics, not so much so, but then, yeah, whatever, no one did well.

That and I hung out playing ultrasound for a while the night before the exam. So, we have an elective ultrasound class taught by fourth years, modeled by second years, that had its first "real" meeting this week on Wednesday night. It was a lot of fun, and ironically, this is better for me understanding locations of structures than all of gross anatomy was. Anyway, I found a liver, kidneys, heart, spleen, and bladder. The best part, however, was hanging out with the fourth years and getting their perspectives on life and med school.

Anyway, I'm "done" till January 3, but I'm getting a start on my neuroanatomy and writing my proposal for this summer's research funding. Without going into too many details it's a cool project in neonatal clinical research. I'm really excited about doing this. But I'm such a geek that way. The more I read, the more I think I want to do this thing. (The big test, of course, will come when I return to the NICU as the clinician, rather than as an observer or as a parent.)

So I'm in a good place.

Our class was having a canned food drive competition with the second years, and I wanted to have my kids get involved. So we got a list for a "kid pack" and got everything on the list. After school today, we let my kids pick out each item (Thomas toothpaste, Sesame Street toothbrush, a huge tub of reduced fat Jif, and so on). Then we drove over to school (husband was in tow, thank goodness) and dropped it off in the med student lounge. We, of course, had to take a tour of the entire school, it seems. Lots of running up and down the aisles of the lecture hall. (It was very hard to explain that this was the room for listening quietly and learning, while my classroom that they'd been to before was the room for working together.) Then I took them upstairs to the ISP lounge and library ("the quiet rooms") and they just loved every minute.

Good day, in all. I can't believe Christmas is in a week and a half. Presents ordered online are coming in and promptly being hidden, but I really do need to wrap them. We never got the house lights up, and I feel astoundingly terrible for this, since I have this "thing" about Christmas - my parents never did much and I hated it. So maybe the lights will go up this weekend. But the tree's been up since the day after Thanksgiving, as well as our mantle decorations, so I'm not too broken up.

I am really realizing that, while it's difficult to have kids and be a medical student, and while life would've been easier if I'd gone when I was 21 (late birthday), I really wouldn't trade my current life for anything. I have beautiful children and an amazing husband who's way smarter than me and who has great dreams of his own. I go to a school that genuinely cares about the practice of medicine. I'm in a program in my school that I love. And I'm learning medicine. Not really the most clinically relevant stuff yet, but still. It's really clear why I'm learning what I'm learning and the answer is not "to pass Step 1."

Pollyanna signing off.

Put this one in the "surreal bedtime conversations" category.

Last night my husband and I are putting the kids to bed. I'm by one son, he's by the other. Here is the conversation:

Him: There is something sticky behind my ear.
Me: It's probably ear wax. Don't worry about it. [My kids have lots of ear wax. This is a regular thing at our house.]
Him: It's not ear wax. It's sweet.
Me: It's probably just candy cane or something. [They'd been eating candy canes.]
Him: Nope - it's peanut butter!
Me: Well, I don't think your ear is a good place to keep your peanut butter; I certainly wouldn't try that.
Him: Why not? It's a great place for peanut butter. Then I can eat it later. It is very good.
(By this point, my husband and I were stifling laughs, and my son keeps trying to convince me that his ear is a great place for peanut butter if he wants to have some later.)

This was, of course, the highlight of my week so far.

An early Happy New Year's to all.

What am I doing? I'm writing a proposal for my summer research scholarship. When is it due? Not for another month. But considering I didn't get any schoolwork (okay, about an hour and a half) done while my kids were on break, and my goal was to have this thing knocked out before Christmas, I'm feeling a little under the gun. After all, my research advisor has to read (and, presumably, edit) it. The head of ISP and my advisor have to sign the thing. And I have to turn it in, in triplicate, I believe.

This is a really cool project, one that will really stretch me without breaking me. Plus, it's a very fascinating area, one which, if I were actually starting my career (rather than starting my education) I'd want to be studying. However - I will say this: my loves in research seem to be *doing* the stuff and *reading* the journal articles. I'm not so into the whole writing thing. Which is ironic because growing up I loved to write. I think I don't enjoy citations, largely because once I've synthesized the material enough to be able to write about it, I've forgotten where I read each bit of it even if I write down sources as I go along.

Christmas was fine, lots of traveling. I think that we will stay home next year. I'm one for "perfect Christmas morning" and I think my home is much better for that than my parents'. It's nice to visit relatives, but perhaps we can do that for Thanksgiving or something.

On our way home, we stopped in the city where my husband and I did undergrad (the same school where I would've gone to medical school, were it not for the little fact that my husband is not a graduate student there, but rather 2.5 hours away). It was a lovely little trip, reminding us that A) the city is, for us, a better city than where we are, but not enough that we'd give up much to live there, and B) the restaurants there are fabulous. (This was why we made an hour detour: we're always craving food from about 3-5 restaurants, but there's not a whole lot else to do on the tourist front, so we've never gone up for a weekend.)

Oh, yeah, and we got rear-ended. It pushed the exhaust pipe way up into the trunk (cracked the bottom of the trunk) and caused all sorts of other problems. We'll find out on Wednesday if our car's totaled, which all of the "responsible" adults in our life think it might be, since the blue book value is only $5k. Dang it, this car was supposed to last till I graduated. It's a Honda Civic with 180K miles, and we were assuming it would make it to 200K. But there are good people in the world. The other driver admitted fault to us, our insurance company, and her insurance company. She was absolutely horrified that it happened. (The road was wet, she braked too hard and slid into the back of our car at a stoplight.)

On that happy note, good night. Merry Christmas, Happy New Year. 2008 will be great. I'm just sure of it.

I'm having a hard time concentrating on my new module so I thought I'd blog a bit.

First, my car is not totaled. :hyper: However, we haven't found time to take it to the Allstate place to get it fixed. (We've got check in hand for $2K.) Eh. We'll find the time eventually.

Let's see... neuroanatomy. This module wasn't as organized as biochem and genetics were, so it took me quite a bit longer than anticipated to "get it." That being said, after procrastinating my exam for, all told, about a week, I did the best I've ever done. I told myself it'd be better to bail and take the exam later, rather than having a fuzzier understanding of the anatomy, which I'd be using, oh, say, now, in neurophysiology. (Hint to all pre-meds: if you find yourself in a poorly organized class take the time to find the order yourself. You will be rewarded.)

So, I think that the very best thing about my school's independent study is the community of it all. Sure, the lecture folks sit together in that big lecture hall for hours on end every day. Sure, they're all taking the tests on the same day. But with us, we've got 30-40 people per class who do things independently, but are all shooting for the same goal. We've got a lounge area connected to our study library, so there's a natural study break area. The second year people are really friendly and I think we get a better notion of the "big picture" of the first two years because of their presence. It does feel like a big, friendly, nerdy family.

In the "fun" stuff for school: we're learning about taking patient histories now. I'll be practicing for the first "official" time next Tuesday. White coat and everything, recorded encounter with standardized patients. And we're doing our BLS certification course. Pretty fun, pretty basic. All of this to set up for a preceptorship later this spring. That's something I'm really looking forward to.

I've turned in my proposal for summer research funding - 3 weeks early. Woo hoo! Now I just have to get accepted. And sometime soon I'll be working with my last-year's research group to submit an abstract for a poster for the spring medical center research day. There are some interesting, interesting findings.

Now, let's see, in my "real life..." One son is really bummed that he didn't get a real rocket that would take him to space for Christmas. He's also kind of disappointed that I don't come to school with him and study my stuff in his classroom. We're also working through getting them to understand that the last of the sippy cups will be thrown away on their birthday next month. (We only do sippy cups for their twice-a-day soy milk, and we've already introduced the replacements.) And we're tossing all the old, nasty training potties, and just leaving a little snap-on thing for the big toilet. They're much cooler with that, now that I've fixed the toilet seat.

Oh, and speaking of home repairs - my husband and I installed a bathroom sink about a week and a half ago. It was a Lowe's sink-in-a-box (all parts included, easy to install, super cheap) to replace our old, leaky, drippy, un-cleanable original cast iron sink that's as old as the house (1920s). It only took 8 hours.

Okay, I'd really better get back to studying. It's always so hard to begin to dig into things. Especially since our text for this module is Kandel's Principles of Neuroscience (1400 extremely heavy pages), our module packet is 90 pages of questions, and our suggested number of study days is 16. Pretty daunting, but I just keep telling myself that after this is cardiovascular physiology and respiratory physiology (2 modules, 1 exam), which *I* think should be interesting, at least.

So, one reason I blog is to have a written record of the priceless things my kids say. Here is tonight's.

The kids and I are finally, after a long evening, heading up to bed.

Him: I need tape, I need tape. (Grabs his Scotch Tape.)
Me: What on earth do you need tape for? It's bedtime. Are you going to tape your bed or something?
Him: No, I am going to tape myself to my bed.
(And off he continues upstairs to bed.)

A Tribute to my Grandmother

My grandmother died yesterday evening.

It was really the best of all possible scenarios, all things considered. She lived alone, perfectly capable of taking care of herself, in the same town as two of her sons, with a mitral valve that was giving out. She collapsed suddenly at my uncle's house (my dad's older brother, her oldest son), and died instantaneously. Any pain she suffered was short, and she was with those she loved when she died, in a familiar place.

She was hospitalized briefly last fall for her valve. This concerned the family, so all 5 sons, and all of my cousins but two, made it to her house for Christmas. They got a family pictures. My sons, who are pretty dicey about showing affection to most relatives, gave her hugs and kisses when we left. Everyone had a chance to say goodbye in a full-of-life sort of way.

She had a stroke when I was a toddler, and triple bypass surgery in 1981. Her health had been pretty much stable ever since. She ate what she wanted, as long as it didn't cause her indigestion (so foods slowly left her diet over the years). In fact, she really was exactly the same as she was when I was a little girl, just with more wrinkles and gray hair. She shoveled her own snow last winter.

She was not a warm woman; she never liked my mother. She was insistent about doing things the way they'd always been done. It was difficult to understand her, partially because of the damage done by her stroke, partially because her uncle had cut off the tip of her tongue when she was a child because of some lesion on the tongue. But her hospitality exceeded that of anyone else I know, and she was my grandmother. The world is emptier without her.

I'm someone who has lots of heroes. Always have.

The first role model I ever had ran into my life in the Summer Olympics of 1984. For those of you who aren't old as dirt like I am (and even for those who are that don't follow these things) 1984 was the first time women could participate in the marathon. The winner was an American elite runner, Joan Benoit. I was so inspired that I went out and ran a mile, as my dad estimated it, around the cul-de-sac where I lived. (16 laps around) That started a 12 year running career, where I firmly believed that if I just worked harder, that could be me. Mind you, I'm a short girl with stubby legs. But I was captain of my high school track team and ran in college.

I've got a ton of heroes now. Starting medical school just shy of your 30th birthday will do that for a woman.

I don't really have heroes for parenting. I'm pretty confident in my abilities there. My youngest aunt is a hero in terms of household and family management, but I really don't want her life, and I like my style of parenting better than anyone else's I've ever met. That just struck me today, and I realized how unusual that is, given the rest of my track record, and the fact that I will be watching said aunt carefully to see how well she and her husband do with their two littlest ones (2.5 and infant) that they had in their early 40s. (You know, because I may not be done having kids yet.)

My grandmother, whom I mentioned in my previous post, isn't really a hero to me. But my two aunts, the wives of my dad's next-older and next-younger brothers, are. They had their own lives. But they took care of and visited my grandmother all the time. They got to know her really well, and in doing so, I learned more from them than I ever learned from my mom, about my grandmother. My mother could never rise above my grandmother's dislike of her and harsh manner to do good for her. My aunts did, and it makes me sad how "out of the loop" I was as a consequence. In the coming years, I'll be having the opportunity to make the same choice regarding my mother-in-law, who's in pretty bad health. Do I rise above the insanity that surrounds this woman to make sure that she is taken care of, or do I respond like my mom, and stay far, far away from the toxic behavior? I think I'd better be like my aunts in this respect.

But as far as career goes, well, that's another story.

My two biggest heroes have got to be two neonatology fellows in the lab group where I was last summer. (Their research is in the cardiovascular group, rather than the perinatal group. Go figure. It got me a chance to meet them, and it's a really cool group, so whatever.) Both of these women started medical school at about 29-30-ish, just like me. Both had kids, just like me. The 3rd year fellow had two kids and an active-duty Air Force husband. And one of her kids was a baby. I figure if she could do it with that going, I've got no excuse. The other one, a first year, I met when she was finishing residency. She had "just" one kid when she started school and had her second during residency. These are some pretty great women, and show me that my career aspirations are totally doable "at my age."

Another hero is my former PI. She's mid-50's, and probably one of the most confident people I know. She does amazing, useful research, and isn't afraid to do what's right. She detests bureaucracy and PC-ness in medicine ("it's all about professionalism" she says - treat the patient and family professionally and the rest will fall into place), and will do what it takes to make sure that her patients receive the best care, and her research is good, meaningful work that benefits people. She's been more than happy to offer me advice even once I was no longer her employee. If I can be the sort of person in my career as she can, I'll be a happy individual.

My small group facilitator is a minor hero. She's only about a year older than me; in fact, she went to medical school with some people I knew from undergrad. :yikes: (I hung out with the class ahead of me, but not because my husband was in that class.) She's a family physician, only a few years out of residency. But she not only *knows* so much stuff (someone in our second year class made the comment about her "Most family physicians are jacks-of-all-trades, master of none, she's a jack-of-all-trades, master of all trades), she exemplifies what it means to be a compassionate physician. She's got a similar parenting philosophy to mine, which is really refreshing to hear in medicine.

Another couple of minor heroes are those that I discovered online. (What a dope I am.) I started reading Drey's blog here a little over a year ago, when I started spending way too much time here on MomMD, and discovered she went to the school that was right in town here, where I was interviewing. (My interview was just a touch over a year ago.) Then I got to meet her last spring. Super nice, fun to be around, great perspective. She didn't really turn into a hero, though, till she gave birth to her daughter, and LESS THAN A MONTH LATER was teaching my class ultrasound during anatomy. Hardcore that Drey is. I like to tell myself that if only one child had popped out of me, I could've been that hardcore. We'll see.

My final, super-minor hero is really just likely because I love her blog, and hope that I can be that successful one day. If you don't read The Underwear Drawer - theunderweardrawer.blogspot.com - you really ought to. She's about my age, she's got a little guy about 18 months younger than my kids, and she's in my very favorite city. She also has some really great comics. Perhaps I'm just obsessed with her city. But I'm an urbanite at heart, languishing in the midwest (though I really, truly believe it's great for me to be here right now so that I can concentrate better on studying), doing the best I can. That, and I prefer $6K preschool tuition over $20+K preschool tuition. Otherwise, there's something totally appealing about not needing to use the car to get everywhere. (I hate driving with a passion that rivals little else.) Someday, if everything works out, I hope to move there, and if I don't, I'll have a good reason why not.

I think that's it for now on my heroes. For a while, I wanted to be a knitting superstar like Alice Starmore or Lily Chin (I'm in one of Lily Chin's books), but now I just want to knit pretty things and not think about what I'm knitting. So I knit socks. Just plain ole socks. (Oh, I think as a knitter going into medicine, I have to view Perri Klass as a hero since she's a knitwear designer-physician, but I dunno. She's okay, I guess. I think it would be hard to make a meaningful contribution to both.)

So, to sum up - I have heroes. Heroes help me to be bigger than myself. Heroes push me to my limits and drive me toward excellence. Whatever your time in life, in medicine, may you, too, find heroes that can do the same for you.

Well, I'm now a mother of two four year olds.

(Anyone who says that the stretch marks go away eventually is mistaken. I still hold out hope, but you can definitely tell I used to have two humans living inside me.)

My husband and I went in today for the birthday celebration at the kids' circle time - a wooden sun was placed in the middle of the circle with the months and seasons on it, and a lit candle in the middle. The kids each had a globe (they wanted to go together) and then they went around the sun once for each year, and talked about things they did at each age, then shared photos from each year. Then the class counted to 4 in lots of different languages: English, Spanish, French, German, Chinese, Korean, Japanese. Pretty special. We'll also be bringing in a cake at lunch. (We're really close to their school.)

However, in light of that, I did choose to postpone my exam till tomorrow morning. I don't want to be rushing back from cake at the kids' school to neurophysiology. Tomorrow will be fine.

I definitely haven't spent enough time studying for this; I'm really getting burned out on the brain. So I'll cut my losses and take what I get on this, rather than dragging it out any farther. (I was barely passing my practice exam yesterday, so one more day of getting the details down will bring me up to my goal area.)

I'll also take this time to give a couple of book reviews, now that my sojourn in neuro is nearly at its close.

FitGerald's Clinical Neuroanatomy and Neuroscience - beautiful pictures, incomprehensible text.
Netter's Concise Neuroanatomy - perfect for getting the anatomy part of neuro - I attribute my success to that book! (This was not required or recommended by my program, but some other guys had it, so I got it; my best investment ever!)
Haines' Neuroanatomy Atlas - worse than useless; lack of colors made it more confusing than anything else (This was recommended; it was terrible.)
Kandel's Principles of Neural Science - enormous (HEAVY!!), intimidating book full of wonderful text and extremely helpful (if ugly) illustrations and explanations. Honestly, I think that the illustrations on this thing are ideal - they convey concepts so well that it doesn't matter that they're poorly colored and not remotely glossy. This book totally rocks. I'd recommend it to anyone.

Q: When is the worst possible time for two little boys with histories of febrile tonic-clonic seizures to spike 102 degree fevers?

A: Right before my neurophysiology exam. For two reasons!

1) Totally scared of seizures. Yes, they are four. The first febrile seizure for both was at age 3, and the most recent one lasted 3 minutes. (Yes, I timed it. With my watch.) Doesn't help that now I *know* what happens, that they're hereditary (I had at least 6 by the time I stopped at age 6.) and that, according to Kandel, multiple seizures can damage the CA1 area of the hippocampus. (Somebody please PM me and tell me that Kandel's not referring to febrile seizures. Or something. I mean, I guess I think my hippocampus is working out just fine...) Anyway, part of me wants to watch them every minute to make sure they don't start seizing. (They've always caught everyone by surprise.)

2) I'm not getting enough sleep with the night-waking, and I've got the guilt complex over my husband taking off of his school stuff for them. (We both decided for me to not push back my exam, since I'd just have to make up the time later, and I won't do any better later this week.)

Anyway, I'm not usually a paranoid, overprotective parent. But seizures are really scary, even when you know that they're generally benign, and calm enough to time them. So fevers will probably continue to scare me till my kids grow out of this.

So - part 2 of 2 for neurophys tomorrow afternoon. I did part 1 this morning, and, well, yeah, it was pretty obvious that I had sick kids. It was not my most shining moment, but I still didn't do terribly. And it was only 4 1/2% of my year 1 grade, so it didn't hurt me too badly.

While I wait to get picked up - the one son did in fact have another seizure today, while I was taking my exam (did exactly the same on the second part as the first). My husband talked to the pediatrician and now we're all headed up there.

Thanks to all who PM-ed me after our last adventure. He's okay, as I suspected. His brother was the most shaken up, since neither boy had ever seen his brother seize. So having the pediatrician tell him that everything was fine was good for both boys.

So, now I'm doing cardio physiology. I really, really like it, but it's taking far longer than I anticipated (I'd hoped to be done by yesterday evening. Nope.) I think part of it is that there's a lot of repetition of concepts in the objectives, since these are some of the most challenging concepts we've had so far.

Some of my classmates study existing objectives that previous students have made. But I found that that's.... boring. I'll admit that I really *like* reading the textbooks. I'd rather read the book, do my objectives, and then spend a few days studying them, than spend the entire 3 weeks studying objectives.

So I'm spending my day at home (since I have no small groups, lectures, or meetings today), reading a chapter, then writing up a chapter, then repeating for the next chapter. 5 down (plus 2 cardio histology), 7 to go! (Then a week on respiratory.) Yeah, I still haven't gotten out of my pajamas. I have done a whole chapter of work, though!

I'm also realizing how *different* people's perceptions of the different modules can be. I was ready and then some to be done with neurophys, and I'm loving cardio, and can't wait for respiratory. But there are many people who are thinking the exact opposite. Neuro had a lot of straight memorization, and was low on the concepts. Cardio and respiratory seem to be the exact opposite. Pressure-volume graphs abound. I guess you either love it or hate it.

Medical school is dangerous for your health.

It started in neurophys, testing all the weird reflexes. Not too dangerous. You can't do too much with that.

Next cardio phys. Can't really do much to alter that. Thank goodness. I was feeling my carotid a. a lot. And studying with a stethoscope is a lot of fun.

Now, I'm in respiratory phys. I nearly made myself pass out 3 times today, just studying. I can't get myself to go back to reflexive breathing. And, yeah, I have asthma, so that wasn't helping matters. I think I'm going to bring my inhaler to school tomorrow.

I think I'm the only one who's liking respiratory more than cardio. I know, the heart's supposed to be the coolest. thing. ever. (Unless you're a brain person.) But I'm really liking the lungs. And the weird ways of testing lung functional residual capacity. Like body plethysmography, which starts out with a person seated in an airtight box, and gets more strange from there.

Hmm. On the horizon are renal and GI. Can't wait to see what those systems make me do. My husband thinks I'm insane. (Uh, am I going to get pregnant during reproductive phys? I mostly hope not. After all, it's only a 6 day module.)

In other news, it looks like I'll be leadership for next year's peds interest group. That's right. Only two of us showed up for the meeting to decide stuff for the next year. And it apparently takes at least 3 people to run the group. But no matter! I'm not involved in anything else at school. Not significantly, anyway. Furthermore, I get to bring my kids to the beginning of the year picnic. (They love going to events at faculty members' homes, particularly when said faculty are grandmotherly physicians.)

One final thing, I will make a little plug for They Might Be Giant's new kids album, Here Come the 1-2-3's. Really well done, great music, fun videos. My kids love it.

Time to write some more. Why wouldn't the night before I take my exam be a great time?

Inspired by a couple of things, I decided to wait a couple of days before taking my cardio and respiratory exams. I'm shocked and amazed at how much more I understand the stuff than I did on Monday, and I'm still at the "recommended" date, nowhere near the max date. We'll see how this pans out. (erasing things superstitiously that are more positive) When people ask (because that's what we do in ISP - ask each other when they're taking the tests) I just say I'm not tired of it yet, so I'm going to keep going.

I'll say that I really, truly love respiratory. Cardio's fine, and if you're going to learn the cardiac cycle, go here http://library.med.utah.edu/kw/pharm/hyper_heart1.html to learn it, but there's just something... elegant about respiratory physiology. (And I think that surfactant is probably the coolest thing in the universe.)

I'll give my book reviews now: Mohrman & Keller's (Lang series) Cardiovascular Physiology works pretty well for me. It's organized well, and reads quickly. Succinct and easy to carry. My favorite book of the module is Schwartzstein and Parker's Respiratory Physiology: A Clinical Approach. Oh, the beauty. Oh, the perfect framework. Oh, the dopey animations on CD that make everything clear. Again, concise, easy to carry, easy to read through quickly. I'm so pleased.

I've also, on the recommendations of others at my school who've done ISP, started using the BRS books along with my modules. Once I'm reasonably clear on what's going on, I read the relevant chapters of the BRS Phys or Histology books. They present it slightly differently, and more summary-ish, but it's really great. And my scores on their end-of-chapter quizzes correlate pretty well with the module packets' practice quizzes. And I like the size of those books, too. (I'm really pathetic that way; I like to pretend I'm reading a novel or something.)

A couple of weeks back, I threw together our digital photos from the boys' first 4 years into an album made with iPhoto. (Apple had 20% off till February 29. I jumped on it.) It's the kids' new favorite book. But I was looking at the backgrounds of the early photos, and realized: my house is SO much cleaner now. You'd think that I'd have had more time to clean when I was a SAHM than I would as a medical student. You'd be pretty much wrong. Two babies/toddlers are way harder than medical school. (Not intellectually, but operationally.) I'm just so proud.

And now, in my irregular running feature of crazy things kids say, some stuff from dinner.

One son:
"People gave me presents when I was a baby. They might have thought I was Jesus."

"Presidents' Day is February [his February birthday - NOT Presidents' Day!]"

Humble is not one of his defining characteristics.

Other son:
"Do people grind up dogs to make hot dogs?" (not touching his hot dog at all - he still would not touch it even when we told him it was beef)

Dinner today was fun.

Ironically, in the end, I did significantly better on cardio. Bizarre. I have no (rational) explanation. But off I go into the land of renal phys. And yes, I'm finding myself needing extra trips to the restroom.

We had a snow day yesterday. That meant, in our case, since we knew the night before, that I went out to school (rode the bus, since our street was an inch thick sheet of ice) early in the morning, then came home for a slightly early dinner. Then my husband went out from dinner till 10, then worked at home till 11:30. Since most of what he does is computer research work, he's got a lot of flexibility when and where he does it, except for meetings, the rare class or presentation, etc. That being said, if time gets suddenly taken away from his day, I find myself doing an awful lot of bedtimes.

One of my sons slept in underwear last night (as opposed to a pull-up) and stayed dry. We'd told him, after a couple of dry nights in a row, that once he stayed dry for a week, he could sleep in underwear. Mostly just letting him know our thoughts on the matter, not trying to motivate. Next thing you know, the week's mostly gone by (I really can't remember when it started) and he's asking to stay in his underwear. So I made sure he went to the bathroom again right before bed, and said okay very hesitantly. But it worked! This morning, he didn't know what to do about getting dressed, since he was already wearing underwear. ("Do I take them off? Do I keep them on? What part of my clothes do I change?") I'll mention this, in part to give hope to others. This son was, at 3 1/2, just starting to be even remotely potty trained. It took going to his new school. After a couple of weeks there, he stopped having accidents entirely. His brother, who's been at least trying for a year now, is still having regular accidents. Kids, even identical twins, who cut teeth, walked, talked, started reading, on the same day, learn things differently.

Off to renal phys.

I thought I'd write tonight, since I think it's significant that I'm spending my Friday night studying. Ordinarily, I try to take at least a couple of nights off per week. However, my kids started spring break on Thursday, and don't go back till next Monday the 31st. So, between my husband and myself, we're "covering" taking care of the kids and getting our own stuff done. Unfortunately, I haven't been able to get ahead enough on my studying, and so I can't take off nearly entirely like I'd planned.

This is pretty stressful to me, since, while I can technically take the time off, if I do, I'll just have to make it up later, and I really don't want to spend my late June finishing my first year. Nope, better to just deal with the stress and stay on the suggested day. (Plus the second years tell us that these modules - renal and GI - are the hardest of med 1.) My big concession is that since the kids don't have school this week, I've reverted to my "natural" hours - rolling in to start my day at 9:30-10, playing with my family 5-7:30, then studying till 1AM.

We did get out to our zoo's family night. We ran into a guy from my school who has kids, a year ahead, but in ISP, so I vaguely know him. (Side note: I always wonder how the wives feel when I meet the SAHM wives of med school husbands, mostly because I'm *really* "mom-like" but also *really* nerdy-med-student.) We also ran into a kid from my sons' preschool class, which was the Most Fun Ever thing for my boys.

I also saw another mom from my former crunchy-hippie SAHM life, but didn't say hi. I couldn't think of anything other than "I learned about celiac disease today, and thought about you." I was always a bit different from these moms, but I feel that the difference has been amplified since I've started med school.

In other news, I have my ultrasound "exam" Monday. That's gotten me a tiny bit stressed, since it took a bunch of time today (that I didn't have because of the kids' spring break), and also that I've had almost *no* practice. We're supposed to have had 4 sessions, and I did my 3rd today. Oh well. Drey from here is one of the 4th year teachers, and so I saw her today. That was fun. I'm positive, though, that part of why I'm such a slow ultrasound learner is because I keep listening to the fun stories the 4th years tell instead of paying attention to the scans.

Obligate funny kid stories:

Last week, when I was doing my renal objectives, my son came downstairs at bedtime, and asked what I was learning. I told him I was learning about pee.
"And tomorrow you will learn about poop?"
"Actually, that's next week."
(He starts cracking up.)
"I want to be a doctor when I grow up."

Earlier this week, both boys were so excited that the school nurse came in to teach them about germs. (They're doing a unit on the human body, and loving every minute.) So, very earnestly, I asked what they learned: "I don't know about germs. I don't learn about them till next month." My other son stands up on his chair at dinner and gives me a five minute lecture on germs. He's asking me now every day when I'm going to learn about germs and can't believe I'm still learning about poop. Neither can I.

Back to the poop. (Well, strictly speaking, digestion and absorption of protein.)

Hm. This has been a difficult week. My kids were on spring break, so my husband and I split time. Unfortunately, we both had a number of things we had to attend, so we didn't get to do rational things like trade off days. This resulted in me getting very little study time, and what study time I had was too stressful to get any real progress made. As a result, I'll be postponing my exam till Thursday. I decided to do both parts on the same day, since I can't make myself study after I've done one part of the exam. So I'll wait till I know both parts and then take the whole thing.

So, renal and GI. Pee and poop. Apparently, the two toughest modules of the year. (Which pale compared to anything second year.) Did I mention I'm feeling quite stressed?

My kids are really ready to go back to school. Their last school day was the Wednesday before Easter, so they've had pretty much a week and a half off. On Tuesday, one son asked, "Uh, Mommy, why aren't we going to school?" This is good to know; they weren't like this at Christmas, since we were traveling. But I think staying at home isn't their thing.

Probably the most interesting thing going on at school is our outpatient preceptorship. We spent January and February learning how to do histories. Now, they're farming us out to area physicians to practice it for 4 half-days before May. We were assigned pretty much randomly (with considerations made for lack-of-transportation and things like that). So, lots of different experiences.

By sheer chance, I ended up with a pediatrician! It's obviously too soon to tell, but this seems like it'll be a boon for me. I relate pretty naturally to kids and their parents. So I've been there once so far, to get to know the physician and his practice, so it was more like a shadowing experience. It's pretty good, but I won't be transferring my kids there, even though it's closer. It's a great experience, and I've already seen some cool stuff. (Premeds: it's way cooler to walk in to an exam room as a med student with your little white coat and stethoscope than it is shadowing as a premed, even if you don't know that much more.)

I still don't know if I've got my summer research funding yet, but I can't really think about it till I get the poster done for last year's study. (Which scares the snot out of me! And it's in a couple of weeks!)

So, to sum up: stress stress stress stress Yay Preceptorship! stress stress stress stress

*And yes, I do know it only gets harder from here, but hopefully, in the future I will have figured out this spring break thing.

Back to studying.

Hi. Whew. I'm finally breathing a bit. Things have gotten a bit on the nutsy side.

I finally (finally) finished renal and GI, and ended up with my two worst scores. Yikes. I'll use this time to (briefly) address the notion that if you're not doing well, you're not working hard. Hm. Not so true. I work exactly the same amount on every module, pretty much about an average time for my class. Some I end up doing really, really well. Others I barely pass. I'm working on figuring out what's going on with our academic counselor (as you can imagine this sort of range with nothing in the middle is stressful), but for the time being, yeah. Way up, way down.

We had our research day today. Back in February I submitted my abstract, and then I spent Friday night (till 4AM) finishing the poster so that I could get it proofread and sent off to the printer. This is an unusual experience to say the least. Gut-wrenching while it's happening, but then in the end... totally worth it. I spent from 2-3PM today talking to people about what a cool project this thing was, and the interesting stuff we learned. I didn't win a prize (no one in my class did, not surprisingly), but just participating got me into the research honor society. And there weren't that many people from my class presenting. It was mostly second years who spent their summer doing research. My study was definitely one of the most "fuzzy," but that's the stuff I like. Real people, real (messy) outcomes.

It was also really nice to spend a little time with my old PI. I'm not going back this summer to work with her, since I want to do neonatology, not general peds (she thinks that's a good fit for me, too, though she would welcome me back if I wanted to go). But she's a super role model, and a great mentor. She trained my preceptor when he was a resident and likes him a lot. And she had lots of pointed questions to make sure I'm doing okay, and differentiating "stressing too much" from "not okay." (The answer is "stressing too much.")

So, here things lie. I panic a bit, and wonder if I won't be able to pull off excellence, and then realize if I do the best I can that's the best I can do.

It's been a rough couple of weeks. I didn't get my summer research funded by the school's research scholarship program. I'll still be funded at the same rate by the PI, but I won't be able to put on my CV "X Memorial Scholarship recipient". I cried when I got my evaluations, one of which was pretty good and had good comments. The other was not-so-nice. Then I made sure to work things out with the PI. So, everything's fine, I guess. But man, research is my *thing*. I'm not just looking for something cool for the summer. It definitely makes me second-guess my notions for an academic career, partially because of my extremely thin skin.

School's... hmm... going. I finally discovered a physiology book that makes sense. Please - if you are studying physiology for med school, or if you will be - get the Costanzo physiology book. (She also writes the BRS Phys book, but this is the full-length deal.) It almost certainly will not go into the depth required for your class (it doesn't for mine) but it makes the material make sense a LOT quicker (especially if you're like me and your physics and general chem are 12 years old) so that you can add in the extra details your professors want you to know. I've even heard of this book recommended for board study if you have the time, though it seems a bit long for that purpose.

But my real reason for writing right now is this - the best book of all is a cookbook, The Mediterranean Vegan Kitchen. We are NOT vegan, or even vegetarian, but it simply has the best non-meat dishes that don't use fake ingredients. The second-best cookbook is the America's Test Kitchen Cookbook... the best general purpose cookbook we've seen. My husband's been making lots of good recipes lately, and I'm really happy with how well we've been eating. Just lovely.

Spring is in full bloom. Our daffodils have been and are going. The orange tulips and lilacs and phlox and those other little purple crawling flowers are in bloom. So beautiful. I study out on my front porch nowadays when I can be at home.

At some point I will come back and give a more real update. In the meantime, though, I want to make sure I get this stuff down before I forget it.

Last Friday I was inducted into our school's research honor society. (Not a terribly big deal; all you have to do is do a poster and present it at the research day.) The keynote speaker (a faculty member I know) had some excellent thoughts that I'll share a few of. (Wow, that's terrible grammar.) Anyway, these are all horribly paraphrased.

-Consider the possibility that as physicians, there is some ethical responsibility to be involved in research. Not necessarily as a day-to-day part of the job, but as a matter of excellence in patient care. What do you do when a patient presents in an unusual way? He spoke well of this, and it resonated.

-Choose mentors wisely.

-Co-mentor your colleagues.

-Do research to answer a question, not study a technique.

-Don't move just for the sake of moving, but be willing to move if another place has what you need for your career.

Anyway, great night, and I'll write more about the chaos of everything else some other time.

I really wanted to become a latte-sipping, Prius-driving, East Coast liberal. But I guess I have to content myself with just being a liberal.

A little over a week ago, my husband got into a fender bender that, because our car was so old (10 year old Civic with 185K miles), totaled the car. Well, it was already declared totaled by the insurance, but this time, the front passenger door doesn't have a good seal, and air whistles in. So we needed to get a new car. Our '02 Miata wasn't getting driven, since, well, we can't drive it in the winter when there's snow/ice on the ground, and we don't drive it much anyway, since school is 2 miles from home, kids' school is 3 (1 from the university), and we only go any farther than that for groceries at Trader Joe's once a week. So we sold the Miata and scoped out options. Used cars that were reliable enough weren't depreciating fast enough to be any cheaper than new cars, so I looked at Consumer Reports' guide to this years' cars. Cars that got "well above average" for reliability, owner satisfaction, and cost of ownership were the only ones considered. There were 3: Honda Fit, Toyota Prius, Mini. Mini was right out, since it was too small and took premium fuel. That left the Fit and the Prius. Unfortunately, even adjusting for gas, the Prius was $100 a month more, so we couldn't afford it. So I don't get to be a Prius driver. (By the way, it's really huge inside! Way bigger than our Civic. And the Fit has the same inside size as our current Civic. So big enough for 2 smallish adults and 2 kids and all the stuff we'd ever carry.)

So all that put me about 3 days behind. I'm still a week ahead of my "max date" but it's definitely hairy. (Oh, and as for the other parts of the latte-sipping, Prius-driving, East Coast liberal - I'm in the midwest for at least another 3 years, even though I was raised in DC, I can only afford Starbucks twice a month or so, and, well, yeah, at least I get to be a liberal.)

I was definitely in that month-away-from-summer slump till Thursday. Everything was just... dragging. I'd be interested in a module till I read through it once, and then lose interest. Completely. So what did I do? Hunker down and study every minute of a day? Give up and eat lots of chocolate? Nah, I spent a morning in the NICU, rounding. It was the best day ever. What do you know, there was something from nearly every module that I did this year that came up in some respect or another, and I was at least mildly successfully pimped! I certainly learned a lot - NICU as a med student is a totally different place than NICU as a mom. And it's where I want to be. The medicine practiced there meshes perfectly with my own leanings and interests. (Compassionate AND scientific? Amazing!) I feel a new motivation to keep going. (And yes, the babies were lovely, but I think we all knew that already.)

Back to the grindstone! Tests on 3 modules Monday! Hurrah! Then OSCE a week later! Then patient-centered medicine exam a week after that! Finally, 2 more module tests and the NBSE shelf board exams! What could be better? (And I'll be finishing my final module "on my own time" before June 30, too. Grr. That's what happens when you get behind. Silly new car and getting sick and other stuff that was going on.)

But, then there's summer. I'll be doing my cool study with some funding, just not scholarship funding. Perhaps I'll tell more, or perhaps I'll stay vague. I'll wait till all the details are ironed out in any case.

So - to sum up - new car, no time to breathe, happy kids, crazy life, good research, new motivation to learn!

Oh yeah, and I lost my keys Wednesday. :ouch: I'm just hoping they're somewhere in my messy house. (See above for excuse for this.)