Thursday, January 10, 2013

Start STEPing

Yep. I'm back. The semester starts again. Over winter break I was an absolute vegetable. A glorious vegetable who had reverted back into a child like state of playing games and eating holiday sweets. I regret nothing. I really was burnt out.

Of course now that I have a couple of days of classes under my belt, I need to get cracking. And more importantly, I need to start rolling out the plan for the step test. Because that's in June.

Yeah. I know. It starts.

For the uninitiated, the STEP exams are our boards. I don't know what the heck it stands for. We get three total, the first two are taken in middle school, and the last one is taken in residency. STEP 1 is the one that people stress about the most by far, because welll... 1.we're at that point in our lives, and 2. the scores you get determine what individual residencies you can apply to. The step is so important, that to get a non competitive score means to discount certain specialties all together. For example, you must score about the 75th percentile or higher to be looking at plastic surgery residency. They're most competitive, so they can afford to be choosy.

The step 1 is taken at the end of second year after all of your basic science courses are out of the way. Then third year you go onto the wards. So before you've experienced what specialties are out there, you already know which ones wont even sniff at you.

So what's a student to do? Well, as long as you don't want to discount anything you haven't tired yet, you study your ass off and shoot for that top 25%. And being med students, it feels like everyone is either a gunner shooting for that top 25%, or a survivalist shooting for the average score of people who shoot for top 25%. Um...if that makes any sense.

So I hatched a plan to a buddy of mine today. We make this into a competition. Not for score. I never set goals for numbers. Weight, scores, money, it's meaningless. You always set goals for the practice and actions it takes to get you to where you want to be. So we're competing in study time.

Here's the rules.

1 block = 25 minutes of study time + 5 minutes of break. If you choose to use your break for more studying, that's you're problem. I chose this number because of the pomodoro technique. http://www.pomodorotechnique.com/

Every block you finish studying materials specifically for the STEP, i.e. not class notes, the other person owes you a dollar.

That's it. If we study consistently and well, then we'll be even and no one owes anything. But given that the hours can add up quickly, it's easy to get caught behind if you slack. After six months, this could easily turn into hundreds of dollars if you left yourself that unprepared. In less than 24 hours, I'm lagging 8 dollars already. oh my.

This could either be one of the worst or best decisions I've ever made in my life. We shall see.

Saturday, December 15, 2012

Cycles.

I feel like my life goes between cycles of panic and exhaustion. Just centered around tests. When I'm good, I'm good. And when life is under stress, that's just my new normal.

I seem to have a good amount of mental willpower. But it only goes all out for one thing at a time. I'm on roll with my school work, or I'm on roll with the personal health thing. Never both, never balanced.

Yeesh. I'm not even really thinking in full sentences right now. Let me start over.

Today I came home and passed out around 5, woke up at 10:30. I'm in the burn out phase of my test cycle where I crash. Tomorrow, I'll come to the realization that I have additional exams on Tuesday, and I'll start ramping up into the panic cycle. This is where you spend every waking hour of your day studying or sitting through class prying your own eyes awake. To keep myself on track, I will call my study buddy, a sweet but sheltered girl who has the most unhealthy relationship with studying that I know. As in, last year her diet was probably 75% ramen (I'm being fucking conservative.) because she 1. didn't have the time to grocery shop, 2. spent so much time on campus studying that she needed shelf life stable foods and 3. could not pull herself away to spend more than a minute thirty to cook a meal.

To boot, despite her immense ability to memorize absolutely everything, her confidence in the material is terribly shaky. Which causes her to study more, which causes her to run herself into the ground more. Despite all of this, she's still always the most kind and friendly person you'll ever meet and is always looking for company...to study. Which you have to steel yourself for. She will pound you with a million questions and if you ask her what to she wants to focus on...the answer is always, always, everything. Let's do ALL the lectures. Lets study as long as possible. I had to start putting my foot down on how often I got myself into this because it's overwhelming.

And it's funny. Because despite being one of the smartest people I know, she puts me on a pedestal. Hanging on every word I say. Yet this may be the first time since lecture I'm looking over the material. Hell, it's almost always the first time since lecture I'm looking over the material.

Now that some background is out of the way, I can go on and continue telling you about the cyclic mess I've gotten myself into. When it gets close enough to crunch time, I just let everything else go and to stick to the plan, I study with her. And we can be dysfunctional together. By the time the test comes around, I'm burnt out again and it all starts over.

But you'd at least get a couple of good days in between crash and panic. But it seems lately, I've let my sleeping schedule get so messed up, that the days between crash and panic are getting shorter. It's just one or the other. I've just got to keep myself up for the next couple of days and I can make it to winter break, reset, and be normal again. Real normal. Not this neo normal, I'm used to bizzaro stress world normal. We're going to make that happen.

I hate to sound stressed and mopey on here, but what I can't stand more is to lie and pretend everything is fine. There's a lot of fun moments that I really do want to write down, but I'm going to save them for winter break. No really! I've got a great story about the teacher they hired to teach the prostate exam to us and the stolen? er borrowed? hotel pool towel he used to clean up with. Yep.

I haven't been updating, but life isn't all bad. I am tired and worn, but I'm not alone in it. And like most of my class, we use humor to get through it. Of course, our humor can get pretty bad, especially when you get into the medical puns. But we take what we can get. ;)

Still, I do feel tired right now. And I feel guilty for being tired. Not because of my classmates. My boyfriend has his own cycles of exhaustion too, but his are with 24 hour on and 48 off shifts. So it's even harder for him to have a normal sleeping schedule, and the guy drives so much. He would never want me to feel this way, but here I am fighting my own mind apparently.

I'm going to get through these next couple of days, but I want my next goal to be tackling my sleeping issues. I'm being a little laxer with the paleo diet lately, because really. I am not in the mood to cook. It's becoming fairly obvious that my bloating problem is a wheat issue more than a milk one. I feel like I've learned something valuable and tangible with that last venture. Of course...now that comes with the added guilt of knowledge. I know exactly what kind of damage I'm doing every time I eat the stuff. This is really changing my relationship with food and I'll leave that subject for another day.

With that being said, I'm going to do my dishes and get back to bed. Thanks for bearing with me. I feel more comfortable about what I've got to do already.

Thursday, November 29, 2012

Hi!

Throwing down a quick post here! Even if it's a bit late.

I did get through the 30 days. For Thanksgiving I gave myself a bit of leeway and just went gluten free, then got back right on the diet.

Then I came back from the break and did one of those freak out things where you realize that you've got four exams back to back and only three days to study for the last of them. So I figured, that hey. If I'm going to do the whole compare and contrast thing of paleo vs non paleo, I might as well do it now. And I just ate whatever was available.

Yeah...I should do that sort of thing step wise. The first day I ate what appeared to be paleo at the cafeteria. Chicken, carrots, and yellow squash. And there was some sort of mystery dijon mustard sauce on the chicken. Oh my. Never again. I had sulfurous burps for the rest of the day and they were so offensive to the taste they made me nauseous. It made you want to pack down anything, any food at all, just to hope it would push it a little further along in the tract.

That doesn't really work by the way.

But the next two days, surprisingly I've had some gas and a bit of bloating, but nothing too crazy. Especially considering what I've been eating on the study march. Yesterday I didn't eat anything until after 3:00 besides two cups of coffee and copious amounts of half and half. I know that's disgusting. I'm not exactly proud of myself. Hell, I'm not even sure how a 60-70% half and half to 40-30% coffee ratio doesn't go rotten when you continually sip on it for hours on end. It's a perfect thing to think about while you're studying the mechanics of food poisoning and enteric infection.

Tomorrow I'm getting groceries and I'm going back on the diet. I feel a bit better on it. My skin feels more touchable. It's clearer. I find myself craving the meats and veggies now.

But I do realize that I have a tendency let everything fall to shit any time school and I stare each other in the face. And some part of me wonders if the fact I lost an entire pant size was due to me just simply not eating enough.  I will always doubt myself like this I suppose. I just can't let be, be. And it's unhealthy. Panic cycles. Yeesh. Something needs to be done about that.

Oh, I feel so sleepy and wonderful and calm right now, though. I'm ready to start the next day and the next block. Post exam relief. It's really good to be done, for the moment.

Wednesday, November 14, 2012

Lessons of the week! I discovered how to get bloated on the paleo diet.


Well, heck. While we're at it, I might as well do the lessons of the week.

There is only one lesson this week. That is...I'm not really feeling Jerusalem Artichokes. They're a tuber that I got in my CSA box. And I figured that they'd be paleo because most tubers are except for white potatoes. Of course looking these guys up, I read that they were high in inulin, so I knew something was up.

Let me explain what inulin is first. It's a type of fiber. But not all fiber is the same. Fiber is made up of multiple sugars arranged in a way that you can't digest. However, each type of fiber has it's own arrangement and overall size. From what I understand the really big fibers promote stool bulking. The little fibers are bacteria food. Or you could see it as big fibers are insoluble, and little fibers are soluble. Inulin is whee in the fiber worst. Probably the wheeist of whee. It is the ultimate bacteria food.

Which hooray! Giving food to your gut bacteria is good! Go pre-biotics!

But anyone who's torn into too many fiber one bars at once well knows that bacteria make gas. And the more you feed them, the more they fart.* Too much inulin at once and you're a certifiable methane chimney.

So I had to get rid of the tubers and I cut them all up for soup. THEM ALL. And now I've got way too much soup going on, filled with way too much inulin stuffed Jerusalem artichokes, and it must be eaten. And I have supped greatly upon it. I'm not going to be able to enter a group study for the next week.

And to top if off I put okra in there too. Why was I tempted by a 79 cent per package sale on okra? What southern roots was I trying to return to? Turned the soup into mucous the first day, thank goodness it's thinned out.

Since when have I gotten so bad at cooking? I feel like I used to be very skilled at this. Something took a turn for the worse when I got into medical school.

---

*Which the blame of course will get passed onto you. Though I'd like to see someone explain away their gas that way. No I didn't fart. That's my microflora.

Updates on life and signing up for a marrow registry

I'm having internet difficulties. It's in the wiring of our apartment. Sort of to be expected since we're talking about a place where you can't even keep the microwave in the kitchen because it'll short out the fridge. Despite this, I'm still attached to my apartment and I wouldn't change it for anything.

So how's the diet going? How's life?

Last Sunday marked the official end of week two. And I was still loosing weight so I upped the amount of fruit and carbs in my diet to slow that down. Which is good, because I'm hanging out at a healthy 125 now. I'm also doing some simple weight lifting exercises and dragged out the pull up bar again. I consider building muscle as protection of my investment.

I'm uncomfortable with the idea of losing too much weight. I've seen what happens to people who lose a fair amount of weight without building muscle in return. You lose your shape. I like having a bit of thickness in my body. So even though I'm fairly certain that the weight that is coming off of me is water, I really don't like the idea of my rib cage showing through my bust. And it will, if I give it the time. So I'm doing pushups. I realize that this is a completely shallow reason to start exercising, but I'm willing to take motivation wherever it comes.

Pushups are tough for me. Always have been. We've fought many a battle. I'm so SO close to being able to do a nice, beautiful, standard push up. Though I did find a good way to modify them two nights ago. My boyfriend agreed to spot me and we took the belt off my robe, then laced it under my chest. He stood over me, one leg on each side, and gave a little tug to the belt when I wasn't quite making it. I image it'd look pretty bad at the gym, but hey. Whatever you do in the privacy of your own home is yours.

Finally I signed up for the bone marrow registry yesterday. Their website is http://www.giftoflife.org/default.aspx. It was something I got pretty interested in when we were doing our autoimmune lectures in pathology. The likely hood that I would be a match to someone is pretty slim. A volunteer told me 1 in 10,000. However the idea that someone out there could share so much with me without being related at all is fascinating. I would be happy to give that person cells. Finding a match is such a slim chance. I really do believe that it's worth any potential hassle to have the widest possible data base. So naturally, I was really excited they were doing a drive at the hospital.

If you're curious how they do the typing on your cells, it's all by check swabs. You bush your cheek with the swab, liking brushing your teeth. Sing a nursery rhyme in your head while you're doing it and you'll be sure to get more than enough time to collect cells. Then you give them the swabs and they type your genetics. If you're 1 in 10,000, you may get to share life with someone some day. Better odds than the lottery.





Sunday, November 4, 2012

First week of straight paleo.

Blew off some much needed steam at the Halloween party last night. Whut? Halloween in November?

Look, med students don't celebrate much of anything on the given day unless it's right after a test.

Anyway, there was a foosball table present, which made me very happy. It's pretty much the closest thing I'll get to team sports. It's a really fun game for me because I'm good enough to play, but novice enough to get a lot of challenge. The game stays interesting that way. My parents can still whip my butt, of course. But if I had the money, and they had the space, that's what I would buy them for Christmas. I'd rather have a foosball table than a television. That's the truth.

In other news, the autopsy I was supposed to attend was canceled, so I rescheduled for right after Thanksgiving. I'm actually sort of happy about this, because I had a discussion paper to write(just finished!) and I also need to discuss creating an advanced directive with my parents for ethics. And of course, there is a LOT of cleaning to do in the fish tank after ignoring them for my exams.

I also need to buy the guys some more food, because right now they're fighting pretty viciously over a piece of zucchini I threw in to tide them over. At least, as much as a goldfish can fight.

But! That is neither here nor there. I'm writing this to give a 1 week update on my paleo diet.

Stuff I've learned going 1 week paleo.

1. I thought I would miss dairy more, but I don't. Having my Yogurt back might be nice, but it's not a major issue for me. Besides....

2. The fridge is exploding with vegetables, and I don't work at it, they'll never be gone. After that huge shopping trip to start myself off with, My first CSA box came in, with more vegetables. Then my boyfriend came over and bought mostly meat, but yet more vegetables. Then the second week rolled around, and my second CSA box came in, with more vegetables. There's a lot of vegetables in my house right now. Let's say it one more time to get it out of my system. Vegetables.

Yet this set up is far superior to what I was doing in the past. For one, I'm getting a variety of veggies from my CSA box. Lots of greens I wouldn't normally buy. So I'm not getting that sick feeling when you eat too much of any one thing. The apartment always has some stock of fresh food in it and there's plenty of meat hoarded in the freezer so I didn't get really weird and starved right before that last test.

Don't get me wrong, my diet was still kinda weird. I get less willing to cook the closer to an exam. On exam day I ate 5 boiled eggs before the day was over + the last grapefruit and the last apple. Still. Five. Boiled. Eggs. I think I'll be sick of those for a while.

3. My sugar cravings are actually becoming quite manageable. My roommates still make a bunch of sweet wonders in the house, and I am always welcome to them. There is a vanilla rum glazed pull and peel pumpkin bread loaf on the counter right now, but it's not particularly tempting. Really, it's not. I can play the taste and texture of it in my head and it might seem pleasant, but it doesn't pull. I haven't gotten any crazy cravings since that first time I ate my apple with cinnamon and cocoa powder. I made the recipe again, and it wasn't nearly as OMG awe inspiring as before.

4. Things have gotten sweeter. Sometimes that's a great thing. The fruit at the Halloween party was awesome last night. Everything was excellent. But sometimes you get a sweet undercurrent from something completely random, like a vegetable or a meat. Just barely there. And you wish it wasn't. It's a bit weird to have so much food taste sweet.

5. I'm continuing to lean out, and it's kinda making me wonder how much water I was holding. It just doesn't make sense to me to drop so much weight so quickly. (and besides my candy cravings, so painlessly). Now I've never been overweight. I am 5'6" and by the end of my first year of medical school I was 139 pounds at my peak. Just ate a bunch of food, feeling bloated, etc. I was 135 in the mornings. Then I went overseas for the summer to work in a clinic, caught a nasty flu, and dropped 10 pounds. I started my year hovering around my undergrad weight of 128, and comfortably went back to 130-132. Now I've only been cutting grain for 2 weeks, but I'm weighing in around 125-127. I feel fine, but it seems to be a bit crazy for me. I'm just a regular sized person. I don't do much exercise beyond walking to class, and running when late. Losing weight this quickly, I'm just suspicious. That's all.

But I did have my period last week so I guess that could explain for continued weight loss? Whatever, If I lose too much, I'm going to start weight lifting again.

6. The only way to keep my eating easy, is to cook too much food and eat left overs for lunch. I don't know the equivalent of a paleo sandwich, and I haven't figured out any "lunchy" foods beyond salad and meat. And screw that. I'd rather eat dinner again.

7. This is weird, but I actually kinda miss my sugar cravings. I mean, what I am going to get all worked up over now? I mean, crap...I'm gonna have to find a new passion in my life or something. If you think it's boring to eat a diet without sweetness, it's not. Because everything changes and starts becoming sweet anyway. What's boring is to feel so dang reasonable about it. You miss the emotional roller coaster that goes with the food. Yeah, I know. It's odd. But there's some truth in there.

Saturday, November 3, 2012

Mobius Strips

Today was hell. The whole week has been leading up to a four exam, all day marathon which had left everyone on edge.

Exam day has almost become a ritual. It starts with the quieter students slowly trickling in, silently collecting around their lab tables and usual spots. It's almost completely silent with just the tapping of computers, flitting through slides to get that last bit in. 

As more people come in, a new atmosphere emerges. You hear pieces of the same conversations, you heard last exam, every exam. The usual -- 'Morning, How are you, How ya feeling sort of stuff. Someone states they feel unprepared, or they're going to die, or that they can't wait for this to just be over. There'll be moans and groans about lost sleep. Exasperated plans to go out as soon as it's over. This is just small talk about the weather. And while the emotion behind the words is essentially preprogramed, it is not meaningless. There's some culturally profound, steel tracks being laid down there. If people expressed whatever "feelings" they were really tumbling with, it would rile up everyone else, be incredibly inappropriate, and down right taboo. 

Ten minutes before the exam, the room's energy crescendos. Pop music is playing, the cheerleader types are burning off nervous energy through flying high fives, the med school weather talk has drowned out into a steady buzz. 140+ souls tightened into springs. Chaos swirling around pockets of agitated silence, still clicking away at slides. 

About 3 minutes before the test, the head cheerleader stands on a center table. This is the sign for everyone to cluster. He gives a cheesy, wonderfully grandiose speech to spur us onward, to battle. And on three, we all shout out the same cry we've held onto since our first anatomy exam, which is really just a muscle with a cool latin name. 

And the energy is a bit happier. Fresher. The test proctors are waiting at this point and rolling their eyes, but we need this. 

Then we enter multiple exams of multiple blocks. If you are done early, you are free to go back to the lab room while you wait for the next block or exam to start. I am typically a very fast exam taker. Once again, you show up early and the few people there are kinda quiet, studying for the next block. But as more people trickle into the holding tank, all hell breaks loose. It's a frenzy of "What did you put on for that troponin question?" and "I can't believe there where so many double negatives with so-and-so's questions! That's not testing your knowledge base at all!" "I've never heard of X, that wasn't in lecture!"

That's when I run and hide to the student lounge. It's wonderfully dark and full of couches, instruments, books, and art. This is sacred no-study grounds. Which means no one is in there talking about the test and I can completely soil it by studying for the next one. In quiet. 

And the day repeats as necessary. 

But between getting caught up in everything and just chugging from one thing to the next, I really missed on something more important today. I fucked up.

Between my first blocks of exams, I ducked into the peaceful room and started working on the next material. I was shaky on it, and I really needed the isolation. A little later a fellow student came in and asked if he could turn the lights down. I replied that of course he could. Laptops are back lit. These are sacred grounds after all. You always defer to someone who wants to take a nap or do non study stuff first. This is the one place in our world where it takes precedence. 

So he laid down and I sat in silence working through my slides. But something was wrong. He was sniffing a lot. But I always doubt my hearing, so I kept working. 

No he's sniffing. He might be crying. So I look up, and there's a bunch of chairs in the way and it's dark, but I can see his feet twisting on each other. Rocking knees. 

And I pause and go back to my slides. But you can't, because there's this person here. And you have no idea what the best course of action is. Because they might need help. But they might not wish it. 

I'm constantly glancing up to try to take in and process what I'm seeing. Which is funny, because I do it in bursts like I'm afraid to be caught being concerned. Because then this person that I barely knew, who always seemed very low stress, who prided himself on this fact in his actions, then I would be calling him out on it while we were only one block down, five to go. And having your pain be publicly recognized is often more painful than the pain itself. I want to protect his pride. 

And I am not ready for whatever unknown that could come out of a person 15 minutes before an exam. My motivations are split 50/50. Which means I feel at least half shitty, self serving person.

It was one of those moments where you know something must be done. The weight of choice presses past you and slows the very rotations of time. And there's silence. He's shuddering.

"You feeling ok?"

"Huh?" His voice sounds fine. 

"You look..." You look like you're crying but I can't tell and I don't want to impose on your valuable nap time (if you're actually sleeping, but you're clearly not) and I really don't want to accuse you of crying because I consider you a very masculine person and I don't want to give you the impression that I   think of you otherwise, because expressing that concern feels like a risk to damaging your pride at the WORST possible time. Ok let my brain *gasp* for breath, "...sick."

Coward.* 

"Oh. I'm fine. Just allergies."

That's bullshit.

"Oh, I have tissues in my purse if you'd like some" It's bullshit, but if that's what he's offering, I'll roll with it.

"No it's fine."

And then we both paused for quite some time. He stopped sniffing, but continued to rustle. I went back to freezing in my thoughts. He checked his clock, I told him it was ok and I was watching the time. About 8 minutes before the next exam he excused himself to go to the bathroom and left. 

For a clear conscience I'm going to need to follow up on this, and quickly before the next window closes. And most likely, I'm going to make an ass of myself in the process. But I'd rather look like one than feel like one.

You add my professor to this, and it's been a weird week. People are really frazzled right now. By Monday, we'll all pretend it never happened. 

Then we'll do it again.

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*I read this piece again, and the flow looked like that word could go to either person. I want to you to know...that's me. I'm referring to. Me. I'm keeping the same wordage because I think keeping my stream of thought intact is important.