DONE!

Yup, I am officially DONE with medical school. My graduation is in mid-May but in my mind I've already finished- yesterday was my last "working" day of med school.

I'm headed off to internship in a little over a month which is a scary thought. I matched into my top choice advanced program and one of my top choice prelim programs. To those of you reading the blog who aren't familiar with this terminology- "Internship" is the first year of residency which lasts from 3 (ie Internal medicine/ Family Practice) to 7 (ie neurosurgery) years. In "categorical" programs, internship is included, whereas in "advanced programs" it isn't, meaning, as in my case, you have to apply separately for a Preliminary year. Radiology, Ophthalmology, Anesthesiology, Neurology, Dermatology, etc, are examples of programs that sometimes require a separate intern year.

It sucks because I have to move twice- but I'm happy with where I matched so it's worth it.

I had to take my illness into account when formulating my match list. Mania, or in my case, hypomania, can actually be triggered by lack of sleep. And, being that it is perfectly legal to work 30 hours in a row, take 10 hours off, and do the same thing again, I had to pick programs with more humane work schedules. Now what I described is rather extreme- the maximum allowed shift is actually 24 hours, but then you're allowed 6 hours (in some places it's 3) for tying up loose ends, etc. People refer to this as "24 + 6" but I'm like, "whatever, it's 30." One program I looked at basically informed applicants that interns who go over hours do so because they are inefficient. That, to me, implied that interns' time sheets likely have them working < 80 hours with no more than 24+6 in a row, while the actual interns are in the hospital longer than that. I didn't rank the program.

There are programs that have a "night float" system which means that there is, as it sounds, a night shift. This means fewer 24 hour shifts for residents. Even thought night float can turn your schedule upside down and mess up your circadian rhythms, I found this to be preferable to a program where I'd be required to work "24 +6" on a regular basis. Both my intern and residency programs have night float.

I also had to think of the prescription drug plans available. I don't see a psychiatrist a lot anymore- it is basically just for crises and medication management- BUT I do take very expensive medications. Seroquel is the worst offender. I REALLY LIKED one prelim program, but had to rank it very low on my list because the prescription coverage was 400 dollars a year. (!!) And, residents had the same health coverage as one of the hospital unions. So much for collective bargaining!

I'm excited about moving on, but also a little sad because I'm leaving the house I've lived in for 4 years. I'll miss my roommates.

Step 2 CS

There are 3 board exams required for licensing. USMLE Step 1 is the first. This is taken after the second year of medical school and covers all the knowledge acquired during the first two years. Neuroscience, genetics, pathology, pharmacology, physiology, epidemiology, and microbiology are some of the subjects included. It's the hardest of the 3 exams, and the score counts the most. The average score is roughly 220. That's the three digit scores. Then there's the two digit score, a mysterious number that isn't a percentage or a percentile. 75 is passing. I have a 230, which correlates to a 98. I'm not sure how one relates to the other.

Some residency programs have "cut off's" and supposedly won't even consider lower scoring applicants. These tend to be the more competitive programs- the ones on the "ROAD" to happiness (Radiology, Ophthalmology, Anesthesiology, Dermatology) as well as Ear Nose and Throat, and Neurosurgery. I'm really not sure how hard and fast these cut-offs are, but I do know that when our Step 1 scores were released, one of my classmates sadly decided that Neurosurgery wasn't in the cards for him. Another was convinced he would never be an a Radiologist. The former chose another field, the latter is a second year Radiology resident.

Step 2 is taken after third year of medical school, the clinical year. It comes in two parts, CK, or Clinical Knowledge, and CS, or Clinical Skills. It's a little easier, and covers mostly clinical medicine. The score for Clinical Knowledge is also given out as a three digit, and the mysterious two digit, score. It's mostly important for those who feel they didn't do well enough on step 1. My score was again, a 230, and this time, my two digit score was a 95. Step 2 Clinical Skills tests students on their patient interactions. Each student must pay over a thousand dollars to interview, and perform physical exams on, actors.

Step 3 is the final test, usually taken during, or after, intern year. It's supposedly the easiest of the three steps, and supposedly, the score counts the least.

Anyway, I'm studying for CS right now. The patients are actors so in many cases they don't have actual physical findings. So, they act. If a patient is supposed to have a heart murmur, he or she will say "hush hush hush" when you put the stethoscope over the chest. No air going into the left lung? The patient holds his breath while moving his shoulders up and down as you hold your stethoscope over the left lung.

And, if you laugh, this means you lack empathy. Laughing puts you in danger of failing, in which case you will have to pay over a thousand dollars to take the test again.

I hope I don't laugh.

"Mentally Ill" Hopkins Resident

I'm still planning on recounting my story through this blog, but that project's on hiatus right now 'cause I'm busy with other things (clerkships, studying...)

Anyway, I happened to come across some news articles online regarding this Hopkins surgery resident who was fired from his program for being "mentally ill." Mentally ill? What do they even mean by that? You can't fire someone simply for being mentally ill. They have to be mentally ill and posing a danger to patients, or some other such thing. It's really odd that this guy's whole career is on the line because someone has decided to label him "mentally ill." Now, technically, depression is a "mental illness" So, all you depressed people out there? Everyone on an SSRI? You're all mentally ill. And you can't work at Hopkins. Schizophrenia is also a mental illness. So, I'm sad to say that if you're schizophrenic, you also will not be able to successfully complete a surgical residency at Hopkins should your secret get out. As for myself, any hope I had of becoming a Hopkins surgery resident was dashed to pieces when I found that those who are "mentally ill" are not welcome.

It's interesting to me that this guy was placed in a broad category that includes severely ill schizophrenics, histrionics with borderline personality disorder, and the depressed. I'm trying to figure out which disorder this guy probably had.

Maybe he had paranoid schizophrenia and was having delusions that those at Johns Hopkins were coaching residents on what to report on an ACGME survey. I think that's it, the most likely diagnosis. The resident, at age 30, presented with paranoid delusions. And anyone who thinks that Hopkins would try to hide anything from the ACGME is crazy, totally nuts. There was that guy a few years ago who seemed to think that "hours" should be "regulated" at Hopkins. That's not really a paranoid delusions, I would call that a bizarre delusion, perhaps. I'm not even sure if that's correct. Well, then he started having paranoid delusions. He held the belief that everyone at Hopkins KNEW that he was the one who complained about these alleged "hours regulations." What a nut case.

The Final Straw

I plugged along for one week at [] hospital. I came into the hospital early in the morning to round on my patients, but there was always something missing when I reported to my resident, a kind and patient third year named William. Actually, there was always a lot missing. I usually hadn't talked to the nurse about overnight events, I usually hadn't looked up the vital signs, I may have looked at the Electronic Medical Record, but I often hadn't looked in the Paper Chart.

As an aside, electronic medical records promise to solve the problems and confusion arising from scattered notes written in illegible handwriting. The hospital was trying to upgrade to a completely electronic system, but, while some of the electronically written notes were easy to read, the changes were creating even more chaos. There were two computer systems- one was older, and the hospital was trying to phase it out. Unfortunately, the new computer system wasn't as user friendly so those used to the old system shied away. And then some people didn't use either, preferring to leave scrawls in the old fashioned "paper chart."

So, when I came in each morning, I was supposed to look up the vitals, carefully recorded by the nurses overnight at 4 hour intervals, in the newer of the two computer systems. Then, I was supposed to check for notes. While in a hospital, a patient may be followed by a particular service, in this case Medicine. But, while there, any number of consults may be called. The patient suddenly develops numbness and tingling? Call Neurology. Questions about a new antibiotic regimen? Call Infectious Diseases. The patient has chest pain? Call Cardiology. Funny vaginal discharge? Call Obstetrics and Gynecology. Broken bones? Orthopedics. So, during the day, any number of clinicians may have visited each patient. And, each department tended to leave notes in different places. Neurology invariably left notes in the new computer system. Obstetrics and Gynecology used both computer systems, so any notes discussing the possible etiologies of vaginal discharge could be found in either. Of course, there were individuals from every consult service who preferred the Paper Chart, leaving an actual tangible note there.

The nurses basically serve as the eyes and ears of the service. Teams of medical students, attendings, and residents constantly switch. A particular resident, for instance, may be on one of the Internal Medicine services for a few weeks and then switch to another service, vacation, or outpatient clinic. Medical students only stayed five weeks in any particular place. And, the attending physicians seemed to rotate as well. A single patient staying in the hospital for any length of time would see a great number of medical students and doctors passing through. Teams of nurses, however, tend to remain on the same floor. Not only that, during their shifts, they actually stay on their assigned floors. Doctors and medical students might be running around to clinics, the operating room, rounds, teaching sessions, or any number of activities, but the nurses are actually present, on the floors, at all times. So every morning, nurses can provide information on how a patient has done overnight. Did the patient spike a fever? Sleep well?

It was generally the job of the medical student to gather and consolidate data in the morning. But with my sudden pathological forgetfullness, this became a nearly impossible task. William took me aside, saying, "Are you confused about what you're supposed to do in the mornings?" I nodded. "I already told you this, you go to the PAPER chart, you go to the COMPUTER, you talk to the NURSES, you talk to the PATIENT, you gather ALL THAT DATA, and then you report to me..." He stopped, looking at me, and then wondered aloud about whether there was something wrong with me. William generally had a look of kind understanding. He was the sort lauded on good bedside manner, the type patients could trust, and the type not to be annoyed without good reason.

"I think I could be a good doctor one day..." I tried to explain that I wasn't usually this forgetful, that this wasn't me, that I didn't know what was wrong, but that I was sure if it was fixed, that eventually, I could function as a doctor. But the mounting tears prevented me from speaking.

"Did you have trouble during first and second year?" asked the resident. The look of kind understanding reappeared on his face. I didn't answer- a tear rolled down my cheek and another threatened to join it. The fact that I had done well during the first two years, that my board scores were excellent, almost made things worse. The resident likely took my silence as agreement. Our conversation ended with him pausing and saying "I don't think you can function in a hospital." He spoke carefully, as though delivering bad news to a patient. He paused, looking at me with a mixture of sympathy, confusion, and annoyance.

The fact that William was mild mannered and didn't routinely abuse those around him made our conversation even worse. I couldn't complain to my classmates over drinks about yet another injustice incurred at the hospital. I couldn't dismiss this or laugh about it later.

I knew he was right. I left the hospital that night and didn't return for nearly a year.

(The above post describes past events, right now I'm in school and doing fine)

My descent into hell

Glendale had a community hospital where the nearby wealthy landed should they not have a medical problem urgent or obscure enough to land them in one of the “fancier” university hospitals in the area. It was a small hospital, contained in one building, and having only four floors. While [my med school's hospital] has a MICU, a PICU, a NICU and a SICU, the last three letters standing for intensive care unit, the first letter standing for medicine, prenatal, neonatal, and surgical, the Glendale hospital had only an ICU which occupied only one part of one floor. The other specialties, medicine, neurology, surgery, pediatrics, and obstetrics and gynecology were distributed throughout the four stories.
After arriving in Glendale, myself and the other two students from [] medical school met briefly with the Course Coordinator, a smiling woman named Joanne, who gave us the keys to our student housing, and ushered us into a conference room to meet the course director, a kindly gray haired internist named Dr. Foulton. Dr. Foulton had a halting way of speaking and often, while trying to recall a specific point, or think through a particular problem would close his eyes and hold his hand up as though shielding himself from sunlight. He had a gentle manner, and a gruff, albeit soft, voice. Dr. Foulton, unlike some attending physicians didn’t STRIDE through the hospital, he walked. He led with a quiet confidence that required no outward reminders of his rank or position. He did have the curious habit of introducing students as doctors and this was the first time I was to hear myself introduced as Dr. Forest. It was unnerving, and had a classmate or nurse introduced me as such, I would have qualified with “STUDENT doctor.”
The student housing at Glendale consisted of three houses- two of which were filled with [my med school] students, and one of which was for med students from [a nearby med school]. That house had only one resident, a medical student doing her family practice rotation. In my house, some students were lucky enough to have single rooms. I shared my room with another [my med school] student named Allisa Carter. Allisa was doing her Ob Gyn rotation and spent more time out of the room than in- an arrangement which suited me well. In fact, when I first moved into the room I didn’t see her for the first couple days and knew only that I was co-habiting with someone who had small feet, expensive shoes, and a penchant for tidiness.
I slowly slipped into a routine- I’d get up at 6 to be at the hospital at half past for pre-rounds where I’d stop by my patients for a brief assessment. Rounds were at 7 sharp, a relatively informal affair lead by Dr. Foulton. We generally stood in the hallway- anyone who had a new patient to present would give Dr. Foulton the run down, and then we, as a group, would visit certain patients. Usually we’d visit new patients, or those with interesting physical findings. One of my patients had aortic stenosis, for instance, and we went to her room where we lined up, one by one, to listen to a heart murmur that radiated from the right side of her upper chest to both sides of her neck. The aortic valve separates the heart from the rest of the circulation, and when the valve is stenotic, meaning it doesn’t open quite enough, the blood flow makes a distinctive noise as it tries to force itself past the too-small orifice. Instead of lub dub lub dub, I recall hearing Bwoosh, Bwoosh, Bwoosh. At the end, Dr. Foulton took the woman’s hand in one of his larger ones, and gently thanked her. When I returned later that day, the woman didn’t wish to see any more medical students.

It was at Glendale that I first noticed things were really wrong. Normally chipper and awake in the mornings, I found myself with eyes closing during rounds. Coffee did little to lift my early morning spirits and I found that this tiredness followed me through the day. While I normally have an excess of energy requiring me to volunteer for duties on other floors, merely for the opportunity to gallop up or down the stairs, at Glendale my feet simply didn’t want to walk, just as my face simply didn’t want to smile. A friendly greeting was as difficult as trying to mold frozen butter. I could muster a smile, but it was more of a grimace. My eyes did not squinch shut and the rest of my face remained frozen. Every morning, I awoke and went to the hospital, but with each step I could barely muster the energy to continue with another. And another. And another. I wanted to melt into the floor and disappear.
My roommate from school called me, but I didn’t return her call. It didn’t seem worth it. Picking up the phone. Talking. Dr. Foulton asked me questions on rounds and I was unable to respond, unable to think. Thoughts slipped from my grasp like melting ice cubes. My psychiatrist quizzed me about my medications. Did any of the medications look different? Had I switched from genetic to brand name or vice versa? Was I taking the medications? She increased my Wellbutrin and Ritalin doses and I emerged from underwater, if only enough to look around and reaffirm what I knew was true. I needed to die. My doctor had prescribed me Ambien, and each night I took enough pills to render me unconscious- I didn’t want to worry about getting to sleep, I didn’t want to remember getting to sleep. Sleep waited for me at the end of each day like the period at the end of a sentence. With 40 mg ambient, sleep was sure. It would happen. And I awaited the end of each day so that I could resume my unconscious state.
I had a favorite computer in a corner where I would sit with my head down, long hair loose around my face, crying as I pretended I was mesmerized wit the computer screen, the keyboard. “You’re the most devoted medical student I’ve ever seen,” said a resident, noting I was always in the hospital. “What else is there?" I wanted to ask. The evenings found me released from the hospital but I was unable to fill my time. I studied, nothing stuck. I watched television, still not comprehending. The medication change helped a little bit, but it was powerless against the immense tide of my depression.
I asked the dean if I could have some time off. That way, I figured, I’d be able to address whatever it was that was dragging me to the bottom of the ocean. And I’d be able to study for my ob-gyn shelf. I just needed a little time and then everything would be OK. I also needed a haircut, but it cost money, and more than that, it cost energy. Because getting to the hair dresser or first finding a hair dresser, then getting to one, would take energy. And for what? My hair hung like a dress that’d been in the back of the closet for 3 years too long.

“Are you safe?” asked Dean Stewart during one conversation. I’d sneaked to one of the hospital bathrooms for this conversation, and told her that yes; I was safe, explaining that there were a number of other students in my house. I wanted to tell her that I wasn’t safe, that even as I spoke to her I was thinking that the bathroom, on the second floor, wasn’t nearly high enough. Were I to jump, I would likely survive. Each day I imagined slicing into my skin with a scalpel, watching a thin line of blood appear as the upper epidermal layer separated, and then seeing the yellow, lumpy fascia as the knife cut deeper. At this point, the edges of the cut would pull apart. My cuts often assumed the shape of a fish- narrow at each end with a wider belly at the center. They never healed as they should have. Instead of sewing the opposite sides together, I let them stay to heal as they would. The scar tissue would fill in and I’d be left with a dark rose reminder. My upper left thigh was filled with such reminders. A doctor once asked what the significance of this part of my body was- and there was none. I’m right handed and when I sit, my right hand is next to my right thigh. I cut on my left thigh once when I ran out of room. I cut on my stomach a few times for the satisfaction of slicing skin that had never been sliced, and I cut on my wrist on three angry occasions.
I wanted to cut but I had no privacy- I shared a bedroom with Allisa, an arrangement that left me unable to cut, unable to dose myself into a 24 our sleep, and unable to binge, hiding the contents in our shared closet. So, every day, I went to work imagining that a car would hit me as I crossed the road. I imagined slipping on the hospital floor and disappearing into a puddle that would evaporate.

One day, Dr. Foulton asked me to speak with him after rounds. I followed him into the conference room and he asked me how I was. I told him I’d had a rough time during Ob-Gyn, but that I’d be fine. “We do not rule through fear and intimidation here,” he said gently. I couldn’t answer; if I opened my mouth I’d start crying. I sat silently, finger in my emotional dyke. He told me that he did have his doubts, that I seemed like a bright young lady. He suggested I seek counseling. He said there was a minimum standard, and that I was not meeting it. I finally offered that I have a mood disorder and said that I was trying to get time off.
“This is the real world,” he said, explaining that if I was having difficulties coping, that taking time off would solve nothing- I would have a brief reprieve and return to the same problems. I wanted him to understand that I wasn’t normally like this, that taking time off would enable me to solve what was wrong so that I could return as an improved individual. He seemed to believe that I needed to handle things and not run away from whatever problems I was experiencing. “I’m not running away! I’m sick! I have an illness! I’ll take time off, recover, and then return,” I wanted to say. But I was silent, finger back in the dyke.

80 Hour Workweeks

"Well, I start work at 6 am so I get tired early," I said to the grocery store clerk, who had just commented on my yawning.

"So, what, you get out at 2?"

"No..."

An 8 hour, or even a 10 hour day has become a luxury. I forget how it is outside of medicine sometimes. There are reminders, though. When I exclaimed that medical students can now get to the hospital later, now at 6 am, my parents, unfamiliar with the world of medicine, didn't really understand how that could be "late" to start work. They also don't understand that a shift may last 24 hours. That people who shouldn't be on the road driving a car, are in the hospital working with desperately ill patients. And they don't understand that this is an improvement.

Resident physicians in hospitals are now legally limited to 80 hours per week of work. There are other stipulations, making 36 hour shifts illegal, and ensuring that there is a reasonable amount of time between shifts so doctors don't have two hours to come home, shower and change scrubs, and return to the hospital.

Many attribute the changes to the Libby Zion case. I don't know many of the specifics of the case- but the gyst is that a young woman named Libby Zion went to the emergency room at a New York hospital and was given medication which interacted with a medication she was on, or an illegal drug she'd been taking- I'm actually not even sure why she went to the ED in the first place, actually. But, anyway, she went to the ED, there were some over-sights, and she ultimately passed away. It turns out that her father's a journalist, so the case gained wide recognition. The mistakes and oversights that were made in the ED were eventually blamed on sleep deprivation and long work hours for residents.

Some seasoned Attending physicians look at that case and dismiss Libby Zion as a cocaine addict who has somehow lead to the ruin of modern medicine, but I think, all things considered, that the diminished work week has been a good thing.

There are arguments against it- some argue that by decreasing hours from 120 to 80, interns have now been cheated out of 40 hours per week of learning and others argue that increased patient pass-offs between residents increase mistakes. Those who protest hours regulations don't like to mention the effects of sleep deprivation upon the doctors, patients, or upon those unfortunate enough to be on the roads while fatigued residents are driving home.

But, whatever the root cause, or whatever the arguments are against hours regulations, I am reaping the benefit and am lucky enough to be entering medicine at a time where there is at least an acknowledgement that long hours are bad.

Civility?

Sometimes I wonder who's actually crazy- me or everyone else. And sometimes it's a hard call.

My school promotes "civility in the learning environment" which basically means that the dean's office works to ensure that medical students are not hit by flying surgical instruments, launched in an operating room temper tantrum, and that we are not routinely humiliated, belittled, or otherwise abused. The dean's office also works to limit student work hours. Working 100 hours a week, coming to the hospital at 4 am, and working for 36 hours in a row, for instance, is no longer tolerated. We're also supposed to average one day off a week.

The dean's office is going to great lengths to ensure what any other reasonable institution outside of medicine would offer automatically.

Now, there are things in the medical school environment that are difficult but that work. Pimping, for instance, is a term used to describe the Socratic Teaching Method. This is where an attending physician asks medical students questions that they may or may not know the answer to. So, why do we use warfarin instead of heparin in this case? What is this (pointing to part of an x ray)? Is this drug metabolized by the kidneys? Yes? What percent of the drug is metabolized by the kidneys? The questions may go on and on. But when done in a benign manner, a student might feel embarassed about the sudden attention to his or her lack of knowledge on the subject of indirect hernias, in rabbits, but the student leaves with a lasting memory of the significance of rabbit hernias.

Incivility is being purposely humiliated in the absence of any detectable learning or teaching. At worst, it may involve physical harm, although I've never had the pleasure of witnessing this. One incident that has forever embedded itself in my mind involves an attending physician I had the pleasure of meeting during a particularly difficult rotation.

For background, this particular medical specialty rotation took place at Madison Hospital (not the real name). Other students having done this rotation at Madison described it as "the worse experience of my adult life," "miserable," "depressing," and any other number of adjectives commonly used to describe a horrific experience.
Every day I travelled 45 minutes to arrive at the hospital at 5 am to round on my patients and I'd generally get out at around 7 pm, unless it was a "short call" day in which case I'd "officially" be done at 10 pm, although this was often subject to interpretation.

Anyway, one particular attending was about to start a didactic session for the medical students, a bunch of the interns, and a bunch of the residents. There were about 20 of us in all. I made a flip comment to someone about how women's lib and chivalry couldn't co-exist.

Attending: Chivalry and womens lib had nothing to do with one another
Me: (thinking- whoops, maybe that was a dumb thing to say; turning bright red) Um
Attending: But, I'm interested, Emily, what are your thoughts on chivalry?
Me: Uh, sorry! (bright red)
Attending: I think Emily has something to say to all of us about chivalry. Go ahead Emily, you have the floor..
Me: (wondering if my comment was inappropriate, still bright red) uh
Attending: We all want to hear what you have to say about Chivalry. Emily is a big expert on chivalry (gesturing)

Meanwhile I had about 20 sets of eyes staring at me. Someone else tried to say something

Attending: No, I think we should all see what EMILY has to say.
Me: (not sure where to look, everyone's staring; I had NO IDEA what to say so I decided to talk about some things I'd read pertaining to the attending's area of expertise) Well, I was reading some papers about gastric cancer and uh
Attending: No, we're all interested in your thoughts on women's lib and CHIVALRY. Please tell us all how the two are related...

After what seemed like forever, it ended. I'm still not sure whether my comment was inappropriate and I certainly never meant to annoy the attending.

I'm not sure if that counts as incivility in the learning environment, but it was embarrasing, unpleasant, and I afterwards regarded this particular attending physician with some amount of fear.

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Surgery

In medical school, we “rotate" through all different specialties so we can pick the one we like the best. Right now I'm "rotating" through surgery.

I actually like surgery. It's the first time this year I've gotten to "scrub in." That’s the hospital term for scrubbing-your-hands-and-forearms-with-brown-colored-sopey-stuff-that-leaves-you-skin-with-a-brownish-hue. The point of scrubbing is to prevent the spread of infection; very important in surgery, as I'm sure you can imagine.

Basically, the operating room is divided into Sterile Areas and everything else. The Sterile areas are noted by their blue color and consist of tables, draped in blue cloth upon which surgical tools sit, the scrub nurse, clad head to foot in a blue surgical hat and robe, and the patient, who once prepped and draped, becomes an honorary member of the sterile field.

Before you scrub in, you can't touch anything that's sterile. That means stay far away from anything and everything that's blue. I still cringe before placing my hands on anything blue outside of the OR. That includes furniture, clothing... I've been trained well.

Once you’re scrubbed, you can’t touch anything that ISN'T sterile, or blue. So after "scrubbing" you walk into the OR, butting the door with your hip, with your hands held up, not too low, because then their not sterile, and not too high, because then their not sterile. Generally, the scrub nurse is an expert in all things sterile, so when entering the OR, I generally look to him/her for instructions which usually consist of- don't put your hands there, your hands are too high, your hands are too low, watch the table... Basically the scrub nurse protects the OR from the medical student.

Anyway, once you're scrubbed and in the OR, the scrub nurse holds up your sterile gown, letting you put your hands in the sleeves. You also do a "twirl" maneuver to tie the sash of the gown, where another person holds part of the sash, and you literally spin around. I felt really uncomfortable with the gowning part of the set up because I felt like having nurses essentially "dress" me was demeaning to them- tantamount to having them fan me and feed me grapes.

But, it's not demeaning, and it's all in the name of sterility. And, once you've been gowned and put on two sets of gloves, you can help out with the actual surgery. Today this involved holding retractors. In the same position. For a long long time.

The World is Coming to an End

At least according to the news.

I can't turn on the television without getting really really depressed about something. I'm worried about houses being in foreclosure (I don't even own a house), I'm worried about the fact that the FDIC insures up to 100,000 dollars, it doesn't seem like enough (I have much, much, much less than that in my bank account), I'm worried that the fed will drop interest rates (?? this might benefit me through my loans), I'm worried about what will happen if there's a bail out (my taxes might increase!!), and what will happen if there isn't a bail out (eek!)...

When I think of my day to day life, it hasn't changed much. My house is near my school so I really don't drive very often, cutting down my transportation expenses as gas prices soar. I live on a medical student diet of Diet Coke, Pasta, and Noon Conference food- my food costs have not increased significantly.

My day to day life has not changed in the slightest. I'm broke, I'm scavenging for free food, I don't drive very often, I'm "paying to work..." yet I have this sense of impending doom. The whole world is falling apart. It's only a matter of time before I go down in flames.

And that's when I turned the channel.

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The Name

So, Emily Forest isn't actually my name- It's not that I'm ashamed of my illness; it's just that it's probably better not to advertise. Especially given my position as a medical student. If I ever become a world famous _________ then I wouldn't try so hard to hide it. But, right now I'm in a position where I, like all others in medical school, have to prove myself, have to come off as professional, able to handle pressure, enthusiastic, trustworthy... all of those adjectives they put on the evaluation sheet next to check boxes indicating "rarely observed" "sometimes observed" all the way to "always observed." And aside from not being professional, able to handle pressure, enthusiastic, trustworthy, you'd better not piss anyone off, particularly on certain rotations, such as ________ (it may be different at different schools- fill in whatever is relevant to you), or you'll end up with a check in the "rarely observed" box.

So, anyway, the name. It's actually my "porn name." One night at summer camp, after "lights out" when we were technically supposed to be sleeping, one of the other girls asked each of us the name of our first pet and the street we grew up on. Basically, if you combine these two entities, you get your "porn name." And, it's supposed to be something like Peppy (your first dog) LaRue (your childhood street). My first pet was named Emily, and I grew up on Forest Street, so I came up with Emily Forest.

And, that is the name I write under. So I can be enthusiastic, together, and trustworthy on the wards.

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First Post

My roommate just told me about a "Mad Pride" movement. It’s sort of like Gay Pride, apparently, except it’s for those with “differently balanced” chemicals. I’ve never heard of any medical conditions that have associated pride movements.

Asthma Pride- the members get together to take beta blockers and smoke in an enclosed area, gasping that they deserve acceptance too, that they shouldn’t have to hide behind inhalers.

I guess Asthma Pride lacks a certain glamour, nobody proudly says, “Van Gogh had asthma,” while puffing away at an inhaler. Nobody attributes any great literary works of genius to hyperactive airways. And nobody claims that asthma attacks are accompanied by bursts of creativity.

I’m bipolar. I’ve had the bursts of creativity, the midnight tattoo runs, I paint, I write, I have great stories… But then there’s the bank account, overdrawn by 2000 dollars, there’s the fact that I now have what I refer to as the “Take-Your-Medication-For-The-Love-Of-God” tattoo, there’s the trail of worried friends and relatives, the hospital stays, the medication…

It’s sort of like when they show these beautiful snowy scenes in movies and on television shows. They don’t necessarily show the day after, when the snow has turned gray and slushy, when your shoes aren’t quite warm enough or waterproof enough to keep your toes safe, leaving you with little white prunes at the end of the day, and when you can’t even shop for groceries because the cars that are turning the snow gray and black are all stuck and blocking traffic, wheels desperately screeching and spinning. But it seems so romantic the day before, little white flecks gently floating out of the sky, children sledding, snowmen… There’s a day after with mental illness too.

I’m not proud of being mad. I accept it, I medicate it, and I manage it so that I can graduate from medical school and become a doctor, hopefully without accruing any more debt, tattoos, or bizarre collections of items that seem like a good idea to purchase at 2 in the morning.

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