ZUMBA!

When I was a kid, I loved to dance. I took ballet first, but the teacher was mean and that dashed my hopes of becoming a professional ballerina. (Don't feel bad; I was five and mainly in it for the tutus anyway.) Then I discovered jazz. I danced my heart out for years. I took lessons with Donna, one of those hardcore jazz/aerobics people from the '80s who rocked the spandex shorts with a neon thong leotard over them. (That part creeped me out, but I figured it meant she was pretty legit.) I'll never forget the year that she placed me at the very front of the group's formation to lead during our end-of-the-year recital. We danced to the theme from Flashdance. It just doesn't get much cooler.

I don't remember why I stopped. It was probably due to other commitments like softball and violin. I always remember my dancing days fondly, though, and I miss having an outlet to let loose to the music like that in the company of others who love it, too. (And in a more organized way than, say, at a club or a wedding.) So when my favorite spinning instructor announced that she would be teaching a Zumba class on Monday nights, it was clear that destiny was calling my name.

Zumba (http://www.zumba.com/us/) is a new workout craze based around Latin dance. It features steps from salsa, merengue, and many other dances and uses really fun, fast-paced music. I tried it tonight and it was fantastic! It was fun because the steps changed with each song, so it was a mental workout too!

It's funny how I'm trying new things during medical school, a time that is notorious for its challenges and jam-packed schedule. I think what's happening, though, is that being frustrated by - and just plain unhappy with - school has made me really ask myself, What do you wish you could do? What makes you happy? in a way that doesn't always happen when I actually do have free time. It's like I'm forced to squeeze as much happiness as I can out of the tiny little moments of freedom that I seize. And I'm getting better and better at doing just that.

Update

The surgery went very smoothly! I can't type very well with just my left hand, so I will write more details later. I lounged around this morning (and got pancakes in bed!) and I'm about to get back to studying. No pain or discomfort, just the awkwardness of having my right arm in a sling. That's all for now!

Surgery

I'm having surgery tomorrow. Well, today, actually. I'm up late trying to keep my mind off of it and also so I can sleep late and minimize the amount of time that I am awake and not allowed to eat anything. (I can't eat past midnight, but I don't have to be at the surgery center until 1PM. I'm going to be cranky.)

It's a minor surgery: an arthroscopic synovectomy. There has been something irritating my elbow joint lining, causing some fluid accumulation that restricts my range of motion, so the surgeon will make some small holes in my elbow, insert tools and a camera, and remove the joint lining. This should take an hour or less, and I will go home afterwards. I don't even have to go to the actual hospital; it will be done in the ambulatory surgery center, which is new and shiny and clean-looking. My doctor has assured me that this most likely isn't anything bad, and other people have assured me that he is an excellent surgeon. My parents and Tay will be in the waiting room the whole time.

And yet I'm scared. I've never had surgery or been under anesthesia. I have reasoned through this so many times in my head, telling myself that this is minor, routine, and being done by very capable people. But deep down I know that there is some tiny, itty-bitty, miniscule chance that things could go badly. And that's what I end up focusing on. The part I have the most trouble with is that I have to completely relinquish control of my body and well-being. I do not enjoy handing over the reins.

So that's why I'm blogging at 1:30 on a Friday morning... to kill time, to sort through my thoughts, and to capture them as they occur, so that perhaps someday when a frightened patient turns to me, I can reassure him or her that I, too, was scared before my first surgery; that I understand exactly what he or she is feeling; and that everything will be alright.

Small Victories

About a week ago, I set out to write a post about what I have begun to recognize as the small victories in my life. I wanted to write about how I used to always sigh longingly when I heard classical music, lamenting my lack of time to play my violin, and how one day I came home and loaded all of my classical music CDs onto my iPod and set the radio station in my car to NPR. Now I hear at least a bit of my beloved strings every day, and even when my drive to school doesn't coincide with a classical broadcast, the intelligent reporting of domestic and world events leaves me feeling that the time was well spent in a way that updates on celebrities' lives on my old radio stations just didn't.

I wanted to write about the fact that Tay and I have managed to establish a habit of attending a spinning class every Sunday morning at 9:15; about how, after joining a new gym, we have (with the help of some personal training sessions) transformed the way we work out. I never thought that we would spend an hour lifting weights together or challenge ourselves to a series of sprints on the elliptical machines, but we do now. Regularly.

But over this past week - that pre-holiday, 3-day school week that was filled with nothing more substantial than holiday parties during childhood but now allows the curriculum to continue full-force until Santa is just about ready to drop down the chimney - I have been discouraged, disheartened, cranky. I realized yesterday that I was not nearly as excited for Christmas as I usually am. (Before you get alarmed, keep in mind that my usual level of excitement rivals that of an entire classroom of kindergarteners, so I'm probably still far ahead of the curve on this one.)

Why? I have boatloads of work to catch up on just to stay on top of my current class, when I had really wanted to devote my 10-day break to reading, writing and editing more of my short stories, and relaxing. Our apartment is begging to be cleaned, and Tay already does more than his fair share of the housework on top of his busy schedule, so I am determined to help out. And I am continually frustrated by my waning drive and level of concentration and by the fact that I have not yet been able to alter my sleep schedule to what I know would be healthier and more efficient. In total I've been feeling pretty blah.

Then yesterday I looked around our apartment, beyond the clutter and dust, and took in our adorable little Christmas tree sitting on our new shelves, surrounded by the glittering gifts that we have carefully picked out for one another and for our families and that we made time to wrap with love and care. I saw the funny, oversized birthday card that I received last Saturday when my friends came out literally in a blizzard to throw a surprise party for me. And I reflected on the wonderful pre-Christmas dinner that we shared with Tay's mom and her boyfriend on Sunday night. And I realized that I could still sit down today and write about small victories.

Merry Christmas everyone!

Courage

I met a man with ALS today. That's Amyotrophic Lateral Sclerosis, or Lou Gehrig's Disease. It causes progressive demyelination of your lower motor neurons; bit by bit, you lose the ability to use your muscles and they weaken and atrophy, though your mind remains completely unaffected. It is irreversible. And fatal.

We just finished a section on neurology, got to meet some "real" patients in the Clinical Skills Center today (as opposed to the actors who we usually see there). Each had a different type of neurological problem: cerebellar atrophy, myasthenia gravis, Parkinson's disease, Guillain-Barre syndrome, stroke. Learning from these patients really made the information stick. I know I have read that treatments for Parkinson's can actually give patients dyskinesia (involuntary movements), but I will never forget seeing the woman today who, having taken her medication an hour earlier, had exchanged the slow shuffling gait and other movement difficulties of Parkinson's for the constant tic-like motion in her arms and legs.

Then we entered the last room, and were instructed to do a motor exam on the man sitting in front of us, who appeared to be approximately 50. His arms were strong - normal biceps and triceps - but his fingers were weaker in comparison. His thighs showed normal strength, but his lower legs and feet did not; he could not push down on the student's hand with his foot, or lift up his foot at all. The physician in the room mentioned that, normally, a good way to test strength in all the leg muscles is to have the patient stand up and then do a squat, but that this was not an option in this patient. Oh no, I thought. I think I know what this is. Please, please let me be wrong.

No such luck. The patient told us that he started noticing weakness and cramping in his legs about 18 months ago. He now has a diagnosis of ALS, and the loss of muscle control continues spreading up his legs and is beginning to affect his hands and wrists.

He told us his story calmly, and got a kick out of the fact that he knew the steps of the motor exam better than we did, as he has been examined by so many neurologists at so many different institutions. He was incredibly generous to allow group after group of students to practice their skills on him. If he saw pity or distress on our faces, he did not show it. In his case, it is not just the clinical findings but his courage and grace that I will remember.

Mega Marathon

Things change during second year. The general structure in most medical schools is that students spend the first year learning how the body is laid out and how it works normally, and then study what can go wrong and how we go about treating it during the second year. An even bigger change than the shift in focus is the approach to testing that my school uses for second-year students. Instead of taking a course, having a few days to study, and then taking a final exam, we take several courses in a row (ranging from 2-4 weeks in length), and then take a series of four exams, all within a few days. Usually the exams consist of two finals for courses, and one exam each for pharmacology and nutrition, courses which run throughout the year. There are five sets of these delightful exam blocks throughout the year. We call them "megas."

The first megas of the year took place over Halloween weekend. That's right, the tests are administered over weekends. They are all given online, and we are allowed to take them at any time and place we would like, as we are bound by the school's honor code to take them honestly anytime within the four days that they are available on the school's testing website. This is both an added convenience and a challenge; yes, one can take them in your pajamas sitting on the futon in your living room, and you can take them in any order, but it can be difficult to set your own deadlines for each in order to leave time to study for the next one.

The first set of megas is rumored to be the hardest. I think this is due to the fact that we don't know what to expect and that it included a month-long course in microbiology (with approximately 150 bacteria/viruses/fungi/protozoa to master), a month-long course in hematology (which can be fairly difficult) and the largest chunk of pharmacology to be tested one one exam. It was an incredibly intense experience, with a week of nonstop studying balanced between several subjects.

In frustration one night, I turned to Tay and finally found the words to truly express what this experience is like: They [professors, administrators, and anyone else who is not currently in medical school but is trying to give advice about it] say that medical school is like a marathon rather than a sprint, that it's a long-term effort, that you must take it slow and steady. But here's the problem: you have to do this marathon at a sprinter's pace! You must go at breakneck speed, only you must keep it up for all 26.2 miles!

Ironically, just a few days later, I picked up Tay's November issue of Men's Health magazine and read an interview with Jason Bateman, whom we had recently seen in Couples Retreat. (The film was hilarious, by the way.) He talks about running and says "Marathons are good training goals. And on the day, you might elect not to wake up at %^&$ing 6 in the morning and go run 26 miles. But you've got 5 months of training behind you, which is nice." Normally I would balk at the idea of not following through with the performance for which you have prepared so diligently, be it athletic or academic. But then I used this idea to further develop the metaphor I had applied to megas, and it dawned on me that, even if a test doesn't go as brilliantly as I had hoped, what really counts for the future is the work that I put into learning the information and the new knowledge that I acquired along the way. Even when going at breakneck speed.

Going in Circles

As you may have guessed, school is back in full swing and I have until now been unsuccessful in my attempts to steal some time for an update. But I have been thinking a lot lately about the whole experience of medical school and the way that the same feelings seem to emerge over and over in me, just directed at different academic topics. It's like going in circles, and it goes something like this:

You start a new class, determined to stay on top of your work. "If, each evening, I study what I've learned each day," you reason, "each new lesson will make sense and will be incorporated into an ever-growing body of knowledge. After going over today's lesson, I will pre-read for tomorrow's classes, and I'll use the weekends to review and solidify the information covered that week. Then, during the study days before the exam, I will study the small details that I may not already know, do practice exam questions, and be all set."

And then classes start and one of two things happens: you get lulled into a false sense of security because the pace doesn't seem that fast right at the beginning (and anyway, you always have the weekend to catch up if you don't fully review today's lectures!) and/or you use that early time, when there is no stress of a looming exam, to catch up on the rest of life (calling friends, answering emails, making doctor appointments, picking out bridesmaid dresses). Then, suddenly - WHAM! A familiar feeling creeps into the pit of your stomach as you eye the calendar and the mere two or three weeks that stand between you and your next-scheduled nemesis (exam), and contemplate the absurdly large pile of notes detailing the information from hours of lectures delivered at breakneck speed that need to be fully digested in that brief time.

Then, in the last week or two before the exam, there will be a few days when you are exceedingly focused and efficient, impressing yourself with your ability to recall minutiae from earlier in the course and just generally covering a lot of information during each study session. "I can do this!" you think. "If I just keep working like this, I will do well on the exam!" Then you will either hear another classmate discussing something he or she has studied that you still know nothing about; or you will read an email from a classmate that contains some question about the subject matter, the answer to which you cannot even fathom; or suddenly you will locate notes from several lectures that you completely forgot existed and that also need to be mastered. Your worldview will spiral downward as you realize, "Oh, my God, I am so behind. There is NO WAY I will ever be prepared for this exam! I am such a terrible student!"

But you must continue studying as hard as possible. And you do, vowing to yourself that next time, next time, you will keep up with the information as it is presented and not let this happen again!

Here's the thing, though: Usually the exam ends up going pretty well. You realize that it is virtually impossible to stay on top of this much information, and that you will never ever know it all. So yes, maybe your classmate knew something that you didn't, but you may know six things that she doesn't. And your score on the tests proves that you must have done something right. But as long as your type-A personality persists (in other words, forever), you will want to do better and to feel in control of your studies. So you will make new promises to yourself at the start of each class, and start the cycle over again.

I often feel as if I'm going in circles, failing over and over again to meet my personal goals of managing my workload and staying fully abreast of my classes. The other day, though, my gaze fell from the stack of pharmacology notes that I needed to learn to the stack of microbiology flashcards that I mastered (albeit in what felt like a last-minute frenzy) last month, and I realized, I'm going through the same thing, but I know more medicine now that I did last time. Perhaps they are not circles through which I travel, retreading the same ground over and over again, but cycles. The ups and downs may be similar, but with each go round, however arduous, my knowledge grows and I inch closer to the real goal.