When you get into 'THE REAL WORLD'...

Three words I really hate: THE REAL WORLD. I've been a student virtually all of my life. Since the age of four with one year off for good behavior. So I've heard this phrase a lot, especially since I became an 'adult' at the age of 18. At the age of 18, I moved out of my parents home never to return and went to school, paying most of my way with scholarships that I earned and loans that I am now paying back.


My year off, immediately after college, wasn't spent touring around Europe on a trust fund or lounging on beaches surfing all day because that part of the world just wasn't that expensive. I moved out of state, got a job and starting getting ready for grad school.


In grad school, I started to understand a little of what people were saying, because the difficulty level went up considerably over college and even over working full time. Life was hard - I don't even like to think of how hard! But that's not even what people meant by THE REAL WORLD.


I think they just mean their world. Whatever their world looks like - whatever grim stressers present themselves to that person every day. If working at jobs I love in a city that thrives is the real world, I'll take it. Yes, I can't wait to get into the real world - I can't wait to be paid a living wage for every hour that I've worked and have my free time be my own without guilt that I should be studying. I can't wait to be able to schedule my vacations any time I want and not just during Christmas or summer holidays.


My very good friend S pointed out that the people who say "wait until..." are the same people who say "enjoy it while you're young" and they are just jealous. I like her advise, which is to just say "I love you even though you're jealous." And I would add, "Just you wait until I'm in the real world!"

Depression?

I think I'm depressed now that school's out. My friend, The Hypnotist, pointed out that finishing school is like losing your job, your community, your partner, your parents and your children all at once. Okay, he didn't say all that, but that's what I got from what he said and that's what I feel like. I feel totally adrift, without schedule, responsibility, commitment or motivation. That's not totally true, because I do get up every morning to go to my taiji class, I work most evenings, I still have lots of friends who are available if I want to play and a partner who is crazy about me - and I do mean crazy, because I wouldn't want to spend that much time with me right now and he still can't get enough. At any rate, I'm struggling because I really don't want to do anything.

I'd like to get out on the river and keep paddling, upstream or down is all the same to me. During my camping trip this weekend, I reminded myself of my mother - always moving, always doing something, always working on the next thing. I just couldn't relax. It's the opposite now that I'm home - I have all this studying to do and I just can't start. I lay in bed eating junk food, drinking Pepsi and watching movies. When I start cleaning the house, I'm able to get a lot done and I think I could clean and reorganize the whole garage in a couple hours if I didn't feel too guilty to take that time away from studying. I can whittle away a whole afternoon if I don't make it too obvious to myself that I'm avoiding my books. I have an appointment with my doctor today and I'm going to pursue medical leave from my boards. It may not be wise, but I also don't think it's wise to go into them without having touched a book.

Regarding friends, I also have this strange feeling about my friends. I've actually written down "call ___" and "make plans with ___" in my task list on my planner. I feel like there is something seriously wrong when plans with friends become a task to complete or accomplish. I recently learned that a good friend is likely moving to Chicago soon and I just felt like closing the circle even more closely to avoid losing friends that way. I feel like I have too many friends (acquaintances) such that my priorities have become unclear - the people I really want to see and spend time with are getting lost in the shuffle.

The final contributor to my disquiet is that I still haven't heard from my birth-father about graduation. I called on fathers day a week before graduation and he said he was proud of me, but didn't say anything about coming (which was a relief because I didn't really want him here), but neither did he send a card or gift. It's not materialism that makes this disappointing, either. It's just the lack of investment that we have in one another. I don't necessarily want to be closer, but I suppose I want him to want to be closer. Not fair, I guess, but I'm the one suffering for it.

Tired of Being Tired

I'm 30 years old and I've been in school for 26 years, excepting summer vacations (for most of that time) and 1 year after undergrad when I didn't know what to do. I've been tired for at least the last three years, although I remember getting sent home during undergrad because of "acute fatigue" where I was almost falling down after walking across campus to school. (I fell asleep in all my classes then. Incidentally, all the mono tests came back negative, but I'm not sure they ever tested me for anemia or thyroid problems.)


I haven't been sleeping well...maybe the heat, maybe wanting A beside me, maybe just being jazzed up from getting off work at 11...and I've been tired most of the day every day...maybe the heat, maybe boredom, maybe procrastination. And I'm tired of feeling tired.


I do all this stuff to make myself more healthy, but I still don't feel strong because I'm always tired. I get up at 6:30 to take the dog out and often don't go back to bed. This week (and the next two) I won't be going back to bed, because I'm taking a 7am Taiji (yes, that's Tai Chi - see How to Read Chinese) class.


Today and Thursday I also see my personal trainer. Since it's been awhile since I trained or took measurements, I got weighed and measured today and low-and-behold I'm up in almost all areas (except my neck, which is two inches smaller than when I started - how's that for interesting?). When I mentioned that I might not buy another training package ($619 for 10 sessions!), he gave me an assignment to write down the top 5 advantages I get from training. I can see where this is going, but I also feel like doing an hour and half of Taiji in the tranquil park setting was more beneficial to my energy than spending an hour pumping iron until my back and legs are screaming for mercy. I don't need a trainer breathing down my two-inch thinner neck to keep me on my cardio, either, especially in summer with options such as kayaking, hiking, rollerblading and cycling. My chiropractor recommends resistance training 6 months a year only, so maybe I'll take the rest of the summer off and re-evaluate then.


And my job - I asked for this wacky schedule where I get off at 10:30-11pm every evening. I thought having my days free would help me study, but unfortunately I'm still not getting anything done, because I spend most of my morning working out, eating then recovering from both of the above. Not sure if this is serving me. Finally, I have been offered a residency for the fall. It's about 50 hours per week and not very well compensated. It's a return to the school environment and a delay in starting my private practice. And I feel like it's going to make and keep me...ding, ding...tired!


I think I need to reinstate my priorities - health, happy home, financial stability and professional success - in that order.

Arbitrary Requirements

Graduation is looming. Only slightly less scary than before since I was offered a residency position last week. I've made arrangements to leave an hour early next Thursday to pick up my mom at the airport and I've gotten a substitute so I can take Friday off to spend time with her. Then I second guessed myself and accepted another shift for Friday - same time, same clinic, different supervising physician. Seems silly, but I really don't want to go back to clinic as a student after graduation.

It's CYA time and I'm Santa-Clausing my list (that is, checking them twice and again) of requirements religiously. I was about to say that I don't know of any religion that requires piotous practice so frequently as I consult my lists, but then I remembered the five daily prayers of Islam and consider that they may actually have one up on me. The requirements for graduating from medical school are vast. Besides passing many exams that show that you know better than to make stupid decisions that will kill your patient, graduates from my program are required to:

• Do 2 new patient intakes - easy!
• perform 5 complete gynecologic exams - I don't know how people don't get this requirement done - it's practically all I did for the first year!
• examine male genitalia twice - done
• perform 2 digital rectal exams - whew, that was easier than expected
  perform 2 "male prostate exams" - I'm glad they didn't expect me to do female prostate exams!
• do a complete physical on 5 patients - piece of cake
• do a physical on 2 babies - fumbled through - don't ever trust me with your children!
• do a physical on 1 elder - did I really never see a person over the age of 60?
• 3 of each manipulation - cervical, thoracic, thorax/ribs, lumbar, sacral - check!
• show competency applying electricity to patients using various devises - wow
• etc. (I actually wanted to list them all, but there are so many! The remaining areas of requirements are minor surgery, homeopathy, nutrition and botanical medicine.)

I currently still have 11 of the above (although most of them fall under the etc. category) to complete. They do seem somewhat arbitrary, though. Why 5 gyn exams, but only 2 male genitalia? Is the female genitalia really that much more complicated?

The number of hours we are required to complete fall under the jurisdiction of the accreditation boards, but here's a look back at what I've completed in terms of recorded hours (my class time is not recorded - these are hours specified under our accreditation):

• Community Service 24
• Hydrotherapy Technician 73.5
• Intro to Clinic 12
• Clinic Education 15
• Lab Practicum 24
• Lab Post 12
• Xray Post 24
• ND Medicinary Practicum 24
• Secondary 292
• Primary 668
• Chinese Medicine Observation 264.5
• Chinese Medicine Internship 629 (projected)
• Chinese Medicine Medicinary 24
• Preceptorship (observing NDs, MDs, DCs etc) 232
• Seminars 48 (attended more, but they only credit us 48)
• Grand Rounds 120
• Grand TOTAL: 2216

In all those hours, I will have seen a minimum of 1100 patients. Wow, I guess I really have done a lot in the last 7 years. It's funny to think I've done all that and still managed to write my blog during my clinic shifts. I am, in fact, on shift now, but since this clinic was flooded over the weekend, we don't have many patients today and I'm leaving momentarily for the final show of strength as I win the wrestling match with the thesis. Prepare to see my fist raised as I defend my title on Tuesday afternoon. Revisions Wednesday and Thursday then turn it in on Friday for a guilt-free graduation on Monday. Oh yes, graduation is looming.

Clap Out

I'm still on moratorium, but I'm just copying from an email I sent my traveling boyfriend, so this doesn't really count...right?

They do "clap out" on Wednesday this week. Clap out is a school tradition. During the very first day of class for the first year class, all the other students in school walk into their class and clap them in and let them know how happy we are that they are a part of our community - and every spring we clap out the graduating class.

I've cried for the past 3 years as the people I started and studied with have graduated through me and I can't believe I have my clap out coming on Wednesday. I've studied here for 7 years. When I first started I only wanted to do 4 years, but after I got cancer, I had to add another year to my program (I didn't take time off, but I had to lighten my load the first year after surgery and couldn't take some classes due to physical restrictions) and then I decided to do the Chinese program, adding another 2 years. Seven years of blood, sweat, tears, but also laughter, love and stronger community than I ever expected.

These people and this place have been have been a part of my life and are inseparable in my memories of losing my father (I found out about his accident at school) and my illness. I also remember being a part of significant parts of others lives at this school - marriages, divorces, innumerable births, my friend's miscarriage of twins, the death of an instructor's wife, losing a beloved instructor, the sudden death of a major figure in our profession and even the suicide of a classmate. A lifetime in seven years . Definitely a lifestyle...as excited as I am to leave school, with all it's restrictions and protections, and start the next phase of my life, I recognize that I've got some grieving to go through because it'll never be the same again.

Oh Lucky Day

Seems like my lucky streak continues...knock on wood!

I found out yesterday that one of the requirements that I might have had to complete after graduation is actually completed. I was misinformed by my harried registrar that certain 'credits' could not be transferred from one area (where I have more than enough) to another area (where I am lacking almost that exact number), and when I went over her head to the dean of the program with my innocent query, the story immediately reversed. Of course I can transfer those over! That eases not only my mind, but also my schedule, since I no longer have to attend my Thursday morning clinic. I enjoyed watching paint dry, I mean watching a chiropractor do body work, but I could really use those mornings to catch up on my sleep and get work done at home.

My school also just approved a decrease in the number of acupuncture patients we are required to see before graduation. If you haven't been through medical school, you may not be aware that there are very exacting requirements about the number of hours spent in clinic, the number of patients one sees in certain capacities and different exams and treatments (called check-offs) one must do before being approved to graduate. For my acupuncture program, we are required to spend 624 hours in the clinic and did have to see 400 patients within that time frame. Doesn't seem like a lot? Try it - keep in mind that this all happens within 1 year after 3 years of academic training and almost 300 hours observing an acupuncturist at work. We're now required to see only 350 patients which is a requirement I have already met. In other words, another load of stress off my mind.

I finished my case paper the other day and will perform several check-offs today, getting that much closer to meeting my complete graduation requirements. I actually think I might finish everything on time.

Requirements remaining: (besides showing up for the rest of my class and clinic shifts)
1. Finish check offs (11 total)
2. Case Presentation: Prostate Cancer
3. 3-4 Page Paper on Chinese Classical Literature
4. Thesis - Finish Writing
5. Thesis - Defend (currently being rescheduled)

Hurry Up and Wait

I worry about being rushed. I hate when it happens and I worry in advance that it will happen. It's almost comical how E rushes me - I'll be waiting for her to finish getting ready - I'll be sitting at my desk just putzing around waiting when she's all the sudden ready and let's go! The quick transition startles me and I feel rushed. That happened on the way to work today and it happens a lot because I'm always ready before her.

A rushes me, but it's not as funny, because he gets really upset about being on IST (Indian Standard Time - read: always late). I've always admired and romanticized the latino ethic of taking ones time, arriving later and slowing things down generally. Apparently that ideal is not shared worldwide. Every party I throw, I'm surprised when people arrive at the time I said the party would start. I usually mean that just as a guideline of when to arrive after. I actually do usually mean the end time that I give, but people never pay as much attention to that part.

Anyways, I hate being rushed and I'm feeling a little rushed abut school these days. Have to hurry up and get my thesis done, hurry up and do a lineage ceremony, hurry up and meet all of my requirements. Hurry up and graduate, hurry up and take boards, hurry up and wait for licensure. I decided to just take my time - I have been approved to walk at graduation even if I don't finish all my requirements including my thesis - so I'm slowing things down...and becoming more effective. I finished my case paper (the last of 6 required for my doctorate) this morning and typed up my last presentation yesterday. Things are definately flowing a little better now that I'm in my stream instead of trying to swim up someone else's schedule.

Knock on Wood

Why am I so hard on myself when I don't do well on something?

Throw a rock and you hit someone who has failed an exam, a class or a task. I feel compassion and understanding for these people and generally assume they aren't carrying that failure around with them because either they learned from it, eventually passed it or turned it into something good. When I was asked in a job interview years ago what my biggest failure had been, I honestly answered that I never felt I had failed at anything. That idealistic optimism still lives within me, but it's harder to remember in the face of slamming doors and that overloud FAIL stamp coming down on my test.

The hardest was the first time, when I wasn't selected for an international clinical operation that I expected to be a shoe-in for. It was easier when I didn't get the residencies I applied for because I knew they were limited. The hardest to date is the test I took yesterday that I fear I may have failed. Calling my mom, because that's what we do in these circumstances, didn't help because she only remembers all the times I've called her in tears during high school and college over some exam that I usually ended up doing well enough to great on. Letting my boyfriend rock me and wipe away my tears helped more than he'll ever know and bitching about my friend who likely did pass helped a lot too. There goes my resolution to stop bitching about people.

I wonder if it's like the time I expressed that I didn't know what true pain felt like and the universe "gifted" me with pain enough to empathize with almost anything. Maybe I should learn to knock on wood.

The End of a Long Race

In 12 short weeks, I will graduate with my doctorate and masters degrees and be officially finished with my education. I might consider another brief foray into graduate education in future, but currently my only plans for further education are self-study of all the topics I missed in school, fun seminars, professional conferences, CE credits and hobby classes such as pottery, dance and guitar (see 101 Goals). I'm at the end of my first week of my final term and my mind and body are reeling from the stress - deadlines, mandatory meetings, a list of arbitrary check-offs that need to be done before they will hand me the paper saying I am qualified to be your physician - and I thought my last term was going to be easy?

I ran into my thesis advisor last night after studiously avoiding him for the prior 12 weeks - it was unavoidable and really informs me that I should have been in contact with him every week of last term because he was able to comfort me in my stress of not having my draft ready to hand in tomorrow. I told him how surprised I was that I still have so much to do before finishing school and that I had erroneously assumed the last term was just showing up, and he pointed out that you don't slow down at the end of a race - you speed up.

How correct he is - that's why I typed this quickly and am not taking the time to spell check.