Silence

I am on pysch. And there is a lot of silence. Uncomfortable silence. The kind of silence where someone sobs.  I don’t like silence. I am a talker. I talk too much. its one of my biggest vices. I am not a good listener. Its something I have had to force myself to change since I have been in medical school.  I am also a doer….and after complaining about int med for 12 solid weeks. I actually missed it a tiny, tiny bit today. I wanted to do something other than just talk about it. This man has terminal cancer…he is depressed. I wanted to call a palliative care consult and read the heme/onc recommendations and call the chaplain.  But my job today was to sit and listen. Sit, listen and wait for him to finish saying what he needed to say.

my resident keeps saying there are many forms of thearpy….he is right.

and like so many moments in medical school I realize again that I am in need of the very medicine I am learning to prescribe in one way or another.  I think we all do.

motion sickness

I went to sleep in August and I woke up and it was almost February. I had the strangest dreams.,,,,,

I was in Brenner’s and this  old man (Dr. Simon ) who I feared and adored asked me if I wanted a power chair and what page I was on in Smith’s book and asked me everything about pediatrics and made me want to study and read and learn.  then there was this wonderful young person who had an unforunate vasuclar issue and had a stroke who every morning when I visited him would recover a new trick to show me.  He walked down the hall before left….then there were kids with pneumonia,  seziures, rashes, diabetes and cerebral palsy who drifted in and. And I was really happy and for the first time in three years top of my class and loved getting up at 5 in the morning (really i did love it).

Then it was Halloweeen and I accidently asked a boy on a date who I barely knew and my sister had her sr awards night and I nearly cried. Then there were these old people with heart attacks and prostate cancer and heart failure oh my gosh EVERYONE HAS HEART FAILURE…..I threw a wedding shower for the first nerd cave wedding (my college suite)…I even made chicken salad and finger sandwhiches and chocolate covered strawberries and party favors….Then there were old people dying left and right of leukemia, breast cancer, sobbing families and pts doing poorly everyday.  I went home everyday feeling emotionally like I had run a marathon. Then a resident who I really respected told me only to apply to community programs because of my disability and I then I sort of hated her or tried hard not to.

I failed miserably at pheblotomy like to the point that it was humilating. I worked in a nursing home and hugged lots of little old ladies who were 95+ and precious and I wanted them to come home with me.  Then I worke in hospice and sang hymns with a drug accdict and watched a young woman die the same way Laura died and cried. Then I went to see Emily in the MACY THANKSGIVING PARADE and it was amazingly fun. We went to see WICKED and ate Yankee turkey and it was actually tasty I kind of accidently went on a date with a boy who used to be a little in a love with me (who just happens to be orthodox jewish) who was depressed.  Then more old people, then gen med which was a lot of heart failure again and my hip started going nuts for no explained reason. Maybe it doesn’t like heart failure.  Got stalked at the holiday ball by the halloween boy and some exchange student from Austria who all the other girls were ga ga over….

Then I went home and literaly watched every movie Matthew McConhauy has been in the last five year with the sisters and ate too much and knitted a scarf and read some books and won some video games and pretended I was 15 again and couldn’t do laundry.  Had the quietest, most peaceful Christmas in years, lots of homemade gifts, quiet bible reading and cheesiness.  Watched Mamama MIa and got a message from the Halloween boy in the middle of it…THEN i had to grow up and put on a big brown dress and let a high school jr at the Mall do my makeup and nails and Em did my hair and then I hated it, then I made her do it again.  Then I helped Karen put on a white dress and marry a boy.  Then I danced with her and LK and BE and LK had a fever and hip flask.  Did I mention it was all a bit like a dream? then there was a three more Christmases with family and more doing nothing.

Then there was heart failure and a new upper level who almost almost made me like adults. And this 20 yo with CF who made me almost like med peds and then a 30 hr call with my first code and watching someone die in front of me with a K of 9.8 and then another code in the same hour. Then my hip just died. And every rounds was something like forever because I couldn’t sit still and then a new upper level who insisted on walk ronds which meant it took longer than forever and I came every day and crashed becuase I hurt so bad. It was time to wake up. Studying for my shelf,  losing a 1500 dollar check temporairly. Taking the shelf, doing fine. realizing that I had learned a lot somewhere in the mist of the hip pain, the heart failure and yankee turkey. Then I was in a car going to Chapel Hill and drinking mixed drinks with BE and LK and talking late, then fall asleep and then I woke up brunch with LK then back to winston. I fell asleep on the sofa.

then I woke up and it was nearly Feburary and my roomate is engaged the other is dating a 30 yr old, the Halloween boy keeps e-mailing me one week and then doesn’t and Dr. Simon sat me down last week and told me that I was top of my peds class and he wanted me to apply to Hopkins.

and suddenly I feel the need to hold on to the rail and keep my hands and arms close and just breathe becuse life is moving too fast.

Appleasing the gatekeepers

I just finished putting together my Step 2 Clinical Skills (CS) (standarized patient exam) Packet. I have to have permission from the National Board of Medical Examiners (NBME) to take my wheelchair and hearing aides with me into the exam.

Over break I went through my medical records (I have my own small archive of films and records taking up an entire corner of the attic) for the first time as a medical student. It was surreal, the words were familiar to me. I speak the language fluently now, grammar, the note structure, the acronyms all make sense. I was looking for my original audiogram (hearing test) and the Kniest diagnosis paperwork.

I had never read the 10 page genetics paperwork fully. Anyone who has ever had any exposure to genetics knows that geneticists are meticulous (I spent a week on it during peds). They look at ever freckle, every toenail  and scrutinize it for answers of what  kind of biochemical diaster you are… I found it, read it, copied it and put in my folder with my audiology stff (hearing aide stuff), letters from the Dean, my high school IEP (plan for accomdation for a student K-12), Wake and my Rheumatologist’s letter. Today I stuffed it in an envlope with a personal statement (yes they require this) explaining my disease, my good standing as a medical student, species, etc. And for some odd reason I felt violated.

I mean the whole thing is ridiculous…I mean would anyone really tell a disabled person they couldn’t take their wheelchair or hearing aides….I mean this exam (which 95% of US grads pass) is one of the tests that decides if I get to be a doctor to deprive me of my hearing aides in particular would severely hurt my chances of doing well. The fact I have to prove to the NBME I need them is just flat out laughable….or is it…see sometimes I forget.

I have forgotten the awkward admission questions, the fact that my friends get rejected because of their disabilities, i forgot the surgery attending who stopped me on the elevator last July to ask how the heck I thought I was going to pass his rotation or the int med attending who stopped rounds half way through on my first day on the service to ask what my limitations were (in front our entire team, nurses, etc) or the peds attending who is a former AAP president who asked me in the middle of morning report what page are YOU on in Smith’s Book (the illustrated peds bible of  genetic syndromes…I am pg 412 (I think)  of the newest edition).  Oh right…I have forgotten I am actually reinventing wheel…

I’m sorry but is it too much to ask to have something sacred here??? Is it absolutely necessary that the people who write my medical liscene have to know every freaking birthmark, freckle and toenail I have???  Do I have no right or privacy…HIPPA applies to everyone except patients who want to be doctors (or lawyers from what I have been told).

and unfortunately its not just the NBME…This week I e-mailed my Rheumatology (arthritis doc) fellow  a question, he is a really decent doc who I really respect. I mentioned my pain had been worse in the past few months on medicine. He wrote me back an answer to my question and then mentioned that my medicine clerkship director (NOT RHEUM) happened to be sharing clinic space and overheard the fellow talking to the Rheum attending about me.  She apparently had a conversation about me with the Rheums, about my work (good, she says) and her sincere desire for me not to be abused on her rotation (good intentions yes).  I know she meant well but if I wanted her to know I would have e-mailed. her .  You know maybe I didn’t need the person writing my medicine grade and comment summary to know the imtiate details of my chronic pain issues.

sigh.

I could go into a long rant about power issues and about history and how such information could be used aganist me by insurance people or yes gatekeepers who have often historically been physicians who made decisions for my tribe without our input. But really its not about that.

I am not ashamed of any of it, I am not afraid of persecution, there is nothing to really hide…I just would like to be a student doctor…who yes happens to use a wheelchair but who mostly just happens to be a  third year medical student who is a decent one at that.

Yes I really would just like to be a medical student.  Why must I keep proving my right to do that?

yes I am a medical student  with a wheelchair, and a big medical file and hearing aides and FLK on my birth certificate.

it time for the world to get over it…I mean at least by the time I graduate.

Let the little children come to me..

ahh yes right I remember now

Break was blissful, lots of movies, sitting on the sofa laughing with the family, sleeping late, eating too much and enjoying my much missed blue ridges. I was dreading coming back considering that I will be first to admit I have been a bitter with school of late.

but its been suprisingly great! I have really, really enjoyed the last three days of general int medicine. I keep pinching myself. I think some of my bitterness truly was I missed the holistic aspects of peds BUT a good portion of it was being burntout and exhausted.

I always knew being a medical student with a chronic illness was not going to be all shiny A pluses, dasies and rainbows but the last two months have been really rough. Its partly the time of year, the cold seems to creep into my joints and hiberate there for the winter.  No matter how much I swim, no matter how much I sleep or take nsaids or meditate or bang my head aganist the wall I am going to wake up swollen, stiff and there are a lot of days I spend a good 5-7 minutes in bed wondering if I get vertical how long I will actually be able to tolerate staying that way….combine that with getting up at 5, attempting to not look like you should be the one in the hospital bed and carrying more patients than ever (not to mention trying to be in a wedding, maintain some sort of vague life outside of my education) and you have my last two months.

Somewhere amongst all of this I have learned some key things….that I am never going to win at the medical knowledge game or the perfect presentation game or the best medical student game and oh right I didn’t go to medical school to do any of those things.

and somehow that has made me saner. I am still swollen, still tired but considerably more content.