med school – Anthony Nuval

the first

On morning rounds, my attending asked me a question. “How long do you think he has?” It wasn’t the usual test-your-knowledge pimping that we’ve gotten used to as doctors in training. She genuinely wanted to know what I thought.

* * *

I’ve been privileged to stand witness only twice.

Six years ago, I drove down to McHenry from Wisconsin to be with my aunt. With her family—her sister, my mom and dad, my brother and his wife–we stood at her bedside as the ventilator was switched off. It was anticipated and planned, for as much as such a thing could be planned given that it was only two weeks earlier that she had successfully had a heart valve replacement and her room was decorated with the well wishes of “get well soon” balloons that were still there.

I really hate those balloons.

Four years ago, we—Scott’s friends—were in the middle of working out a schedule so that one of us would always be around to provide support for his mom, who had been with him every minute of his hospital stay. It was nighttime and I was getting ready to go back home to Wisconsin to show my face at work before coming back for my scheduled support shift, but our plans were soon to become moot. I don’t know what his prognosis had been—did he have hours? days? weeks? months?—maybe I was being purposefully ignorant—but we had been preparing for the long haul.

Scott had a group of close friends that had been with him since high school, but he and I only became friends many years later. They were present for his passing, with the exception of Joe. I asked Michael why I should have been there and not Joe.

“You needed to be there to get the story,” just as he so often is, to be the keeper of the story.

* * *

I wasn’t present when he passed away. I arrived at the hospital in the morning and asked my intern if he had seen him yet. “He passed away about an hour ago.”

When my attending asked me how long I thought he had, I sighed and shook my head. I thought of my aunt. I thought of Scott. “I don’t know. Maybe a day.”

Sometimes, there is no reward in being right.

your mileage may vary

life, Medicine, Ho!

First year. It started out as a joke. “I left my career for this?!”

Med school and I were still on our honeymoon. There was a lot to study, but I remembered enough from my prerequisite science courses and I learned enough physiology on the job that it was bearable. There was still free time, time to volunteer, time to hang out with friends and family. It was almost like being in college again.

Second year. The fire hose of knowledge that one is expected to handle was wide open. The stack of pancakes that is daily studying grew high enough to rival the tallest buildings. People were unhappy with the recent changes to the curriculum. Negativity was everywhere. The stress of studying for our first board exam was wearing everyone down. I was worn out. “I left my career for this?!”

It wasn’t that I loathed my job or that I wasn’t good at it. I was good at it. My manager’s manager told me up front, in an effort to get me to stay, that there would be an irreplaceable void in the team when I left. But the truth is that it took me a long time to get to that point, to develop competence and credibility.

And here I was starting all over again.

Continue reading “your mileage may vary” →

2012 post-mortem

life, Medicine, Ho!

With just over three days left in the calendar year, I caught up with Joe, an old friend from my post-bacc. It had been about four months since we last hung out, but with the way life has been going, it might as well have been ages. “How’s it been?” he asked.

I said, “Well…I’m still standing.”

Finishing up M1 year wasn’t too bad. If you asked me then, I would say that it wasn’t easy, but everything’s relative, of course. In this case, relative to our first block of M2 year, the first time my school was doing a block/systems organization for M2 year, M1 year was a cakewalk. Slogging through that first M2 block was like having to partake from a fire hose dispensing not water but pancakes at high pressure, which you might attempt bravely to eat but all that happens is you end up as the battered, worn-down survivor of flapjack-force trauma and maybe, hopefully, you ate enough to pass the exams.

With no time to recover between blocks, with stressed-out friends all around, the rest of the semester was spent treading water (or is it pancakes), not really being able to focus on anything but the immediate (and not even doing a good job at that). In the face of the ramped-up stressfest that M2 year was proving to be, maintaining my usual outward composure was coming at a high internal cost when I already had little emotional reserve to spare. I tried to remember how I handled things the last time I felt this way. I thought of Scott. I thought of the price I was paying for this change in direction in my life, the seven years (minimum) I was giving up in order to retrain; the lost income, the down-prioritization of friends, of family, of love. The implications of changing careers felt quite different now that I was firmly on the other side of 30.

Over Thanksgiving break, I finished a couple of books I had begun to read before first year started.

“To go through medical training, you have to resign yourself to long periods of time when you will simply do an inadequate job with all the people who mean most to you.” –Perri Klass, A Not Entirely Benign Procedure

“Life is bigger than what the trajectory of our medical careers will allow. And just because medicine tries to consume our entire lives doesn’t mean we have to willingly hand them over.” –Michelle Au, This Won’t Hurt a Bit (and other white lies)

If I read those words before starting school, they wouldn’t resonate quite so palpably. Those other things–otherwise stated, the more important things in life, the things taking a back seat to school–are what makes this worthwhile, what makes it possible to dedicate oneself in turn to the service of others.

The end of the semester eventually came, and with it no failing grades and a temporary reprieve from school, but no real resolution, for the cycle would only start anew in due time–and it only gets worse. All I can say is that this is the new normal–and hopefully I figure out how to reclaim what’s important in my life from this all-consuming beast that is medicine.

2012: project 366 kickoff

life

(1/366)

So many days have gone by since starting school and it’s all a blur to me. I think this is what happens when something–in this case, studying–is so consuming as to nullify any awareness of the world around you. On one level, this perception of the passage of time is a good thing, as I want nothing more than to be out of the classroom and in my clinical rotations, learning how to do the stuff I actually want to do; but on another, every day that goes by without so much as registering in my consciousness feels like a waste of a day. And days aren’t exactly an infinite commodity.

There were ways to slow things down that I used to do a lot of. Write. Take pictures. Only nowadays it seems like I don’t have time for that because of school. Well, that’s not entirely accurate. I could make the time, but I need to improve my studying discipline: it presently sucks.

I think I’m going to try to write more in addition to this (and I’m definitely going to have to make sure I’m on the ball with my studies), but because my earlier Project 365 seemed to work brilliantly, here goes one for 2012. And because 2012 is a leap year, it’s actually a Project 366. The aim is the same, though.

So. Let’s begin.

first quarter review

Medicine, Ho!

One quarter down, five exams completed, five passing grades. So far, so good. P=MD. That doesn’t mean that it was easy (not that I was expecting it to be), but I could definitely do without that sense of uneasiness over the question of “did I pass?” after each exam, the likes of which haven’t been seen since organic chemistry (for which, in those days, the prescription was this drink). I don’t recall noticing it back in undergrad, but I suspect that’s because studying engineering exercises a completely different part of one’s brain (mmm…math). As a practicing engineer, life consisted of analysis and problem-solving (and let’s not forget the metric tons of documentation generated) instead of memorizing and regurgitating. And so, there’s a bit of an adjustment period. Eventually, I’ll get to use more of those brain muscles, but first I have to learn the language. And it is basically just that–you have to learn the alphabet, then simple words, then simple sentences, before you can start to begin to think critically.

(On the other hand, if I want to be really cynical, I could say that learning about the human body is like trying to reverse-engineer a system for which no one from the original design team is still employed and zero requirements or design documents exist and you’re like “who the hell designed this shit” and you have a gazillion customers with broken systems all demanding they be fixed and you can’t just tell them to buy the upgrade.)

But the mechanics of studying and doing well on exams are fairly straightforward. It’s simple enough to analyze what I’m doing wrong and devise a corrected plan of action. (Following through on that plan is another story.) I’d much rather deconstruct the psychological aspects of being a med student who went the non-traditional route. First, some words of wisdom (from an Internet board that shall go unidentified):

…I actually had a board member pause the interview just so he could advise me not to lose the identity I’ve developed (as a non-trad with a career) because apparently many non-trads “regress” (as he put it) once they’re in med school surrounded by much younger students.

For non-trads, the difficulty is that you’re not just developing your adult identity, you’re taking on a new adult identity on top of the one(s) that you already have.

I read these quotes at the start of the quarter, but it’s not until now that they’ve started to ring true. It’s all too easy (especially for someone who doesn’t look all that different from his new peers) to assimilate into the culture and thus feel like one’s identity is being lost. Maybe that’s why I feel the need to assert myself as that old fogey of an engineer every so often; but doing so may also have the detrimental effect of creating too much of a separation between my classmates and me, or perhaps coming off as having airs when that couldn’t be further from the truth. And sometimes it’s hard to contribute the perspective of someone who’s had a bit more time to percolate and has a bit more experience without sounding preachy or condescending. So, there’s a balance that must be struck.

I don’t even have a clue as of yet what this new adult identity is that I’m crafting.

But in the end, it’s just an interesting thought exercise that I won’t get any credit for. For now, the order of business is to relax, rest, and recharge, ready to hit the ground running when the next quarter begins. (And given that it’s the cardiovascular/pulmonary block, if I don’t ace it, I should just quit right then.) Here is one more quote I found hilarious:

But the life arc is undeniable. I couldn’t stay in a night club with 18 to 25 y/o’s with sh!tty music pumping unless I was seven different kinds of loaded. And I’m not into that anymore. So.

3Q29 report

life, Medicine, Ho!

(274/365)

It’s probably a good sign that I haven’t felt much need to post anything lately. Were it not for the end of the third quarter of year 29, I might have let November go without a post and kept October company.

Probably all that needs to be noted (and it’s old news for anyone keeping up with my Facebook status updates) is that my long national nightmare of disposable income now definitely has an end date (see the Countdown to Freedom in the blog sidebar). The anxiety of “will I get in somewhere” has since been replaced by “will I have a choice of where to go,” which is at least less stress-inducing but still admittedly tied to feelings of self-worth, however irrational it may be—yes, the applicant pool is beyond saturated with qualified candidates, but I wouldn’t be human if I said my ego doesn’t bruise at least somewhat from rejection.

I suppose all that’s left for this last quarter before I turn 30 is to have fun and enjoy it, but I’m hard pressed to remember a winter that wasn’t colored with some sort of melancholia…

2Q29 report

life, Medicine, Ho!

(182/365)

The midpoint of year 29 kind of snuck up on me. I suppose that’s because these last three months have been a whirlwind of activity: with med school secondary apps (19) and Red Cross shifts (100+ hours) on top of the usual work responsibilities, it’s been busy, but in a good way. (Well. I can say that now, but in the thick of essay-writing, I think I had different emotions.) It has given this latest quarter a different quality than the one before it, feeling more purposeful and less like merely treading water. There are glimmers of hope for the future, maybe from proofreading my secondaries numerous times; they are tempered by doses of realism, but in the end, optimism wins out, buoyed by the sense that I’ve found what I want to do.

Maybe it’s fitting that this past weekend I hit the ground running to start this third quarter, logging some not-uneventful hours at Irish Fest, but the tone for this quarter will be set by the folks on the various admissions committees and whether they like what they read…

grade me…evaluate and rank me…

life, Medicine, Ho!, Musings

In the days following clicking “Submit” on my primary med school application, that initial sense of accomplishment has been increasingly replaced by a sense of dread, realizing that, by having done so, I am subjecting myself to critique and judgment orders of magnitude beyond the yearly employee performance review. I suspect this may not be so bad for the more typical med school applicant, who hasn’t had time enough to develop not only a significant body of experience but a sense of…well, I guess it’s entitlement. Not so much the “I’ve had everything spoon-fed to me and I expect it to continue” unjustified sense so much as the “I’ve paid my dues and then some–to reject me is an injustice” unjustified sense of entitlement. But, in line with not self-identifying with the “entitlement generation,” any feelings of indignation I might feel are subsumed by worry–worry that I didn’t market myself well enough on my application, that I might be judged unqualified or unprepared; and then where would that leave me? (“Oh, yeah? Well, I’m gonna build my own med school. With blackjack. And hookers. In fact…forget the school.”)

Humility. I should keep that in mind.

And there’s so much waiting. Waiting for my transcripts to be verified, waiting for secondaries, waiting for interviews… one foot is moving towards the future, but the other foot has to stay in the present and take care of present responsibilities, despite all desire to continue moving forward, making the wait more intolerable. Oh, and the uncertainty. None of what I’ve done so far is guaranteed to result in the outcome I want. (Amusing thought: does the uncertainty principle imply that if I knew that I made it into med school, I would have no idea what I did to get there?)

Maybe I need an actual vacation…especially before the secondary applications start to kick my ass.

red cross training, part one.

Medicine, Ho!, service

(15/365)

Completing my first in a series of FAST training workshops yesterday, this one on trauma emergencies, it seems to me that this is not unlike what med school will be like: there’s a lot of information being launched furiously at you in a short amount of time and you’re expected to pick it up just as fast, but none of it will actually start to make sense or be internalized until you actually start on the job. It’s certainly not unique to medicine, but the experience is something I haven’t needed to go through in well over six years.

What I suspect isn’t quite like med school is the diversity of backgrounds of everyone who’s volunteering. There are medical professionals, sure, but there are quite a few self-proclaimed non-medical professionals–IT professionals/computer geeks–participating as well. Given my own motivations, it’s unsurprising. From my conversations with them so far, the running theme is that they aren’t completely fulfilled or otherwise satisfied by their jobs, usually because of the sedentary aspect of the job and because there’s little sense of having made a difference. And so it is that they came to volunteer for the Red Cross.

Beyond the full-time job holders are the students, some pre-meds, some of whom are switching into medicine after having studied something completely unrelated in their undergrad careers. I met two fine arts post-baccs who are slogging through pre-med classes, and of course I had to ask if they had already hit organic chemistry (isn’t that the bane of every pre-med’s existence?), but they couldn’t relate to that particular misery yet. We talked shop more than anything else–classes, MCATs, applying to med schools–but I would have liked to have found out more about why they’re changing course in life. It’s always interesting to me to hear the reasons why people decide to pursue a career in medicine; plus, it gives me a chance to continue hashing out for myself my own reasons for what I’m doing.

All in all, it was a good session, learning a lot and interacting with a variety of people. There were definitely some insecurities to work through, though. It’ll fade as I get into the swing of things, no doubt; I just wish I didn’t have to wait until the next workshop in April.

what’s in a name, and in a similar vein.

life, Medicine, Ho!, Musings, school

At tonight’s FAST orientation, I did something I haven’t done in awhile: introduce myself as “Tony.”* It was kind of a spur-of-the-moment choice occurring while filling out a stick-on name badge; a question not normally asked but nonetheless answered, in the blink of an eye; an action ostensibly with no consequence, though, in retrospect, laden with symbolism. It was a small gesture that signifies, I think, by its nature, a new beginning; the anticipation of not just a new decade but a new path in life; and at the same time, harking back to a distant former existence, a return to what was.

Oh, and the orientation was rather inspiring. I am now booked for something like 25 hours of training and at least as much of actual service–and wishing I had found this team sooner.

* * *

The name of a blog that Saralyn, a fellow Northwestern SCS pre-med survivor, is rebooting, “Med School Maybe,” reminds me that this whole becoming-a-doctor thing isn’t written in stone…being accepted to a med school somewhere isn’t guaranteed at all, and there is a ton of crap yet to be done just to get my application ready. Hell, when was the last time I actually applied for anything? Must have been my job interview…six years ago. It’s vaguely reminiscent of the panic and worry over college apps. With grad school apps, or even the job interview with GE, there was less of a concern since I had fallback plans, so you’d think that should be the case here, but I’m really waiting for the other shoe to drop. Med school admissions committees: I should think that going through the hell of applying to med school when I’ve got a reasonably secure** job that allows me to contribute something to society shows some level of commitment.

* Ever since I graduated from high school, I would always first introduce myself as “Anthony,” answering “either is fine” if then asked if I preferred “Anthony” or “Tony.” During high school, though, it was pretty much “Tony.” And if I met someone through a high school friend, or if someone were associated with my high school, I would introduce myself as “Tony.” Come to think of it, it might have been a mixed bag during college.

** No doubt that, by stating that, I’ve now jinxed it.