It just got real

You know how sometimes you look forward to (or dread) something for so long that it feels like it will always be looming somewhere out there in the future, will never be right at hand, never really occur? And then one day it sort of smacks you in the forehead and announces, "Hello, I'm here! I'm happening!"?

I'm taking Step 1 of the medical licensing boards on June 21. My last class of the pre-clinical years (the last class before my intense month of studying for the boards) starts on Monday.

Tay and I are getting married on June 26. Invitations go out tomorrow.

Oh yeah, things just got real.

If you're like me, you think you'll have everything all worked out by the time that the thing you're anticipating actually rolls around; you think you'll have completely reviewed and re-mastered all of microbiology and pharmacology as sort of a pre-study before the real boards-studying commences, and that you'll have your ceremony all written and your abs all flattened long before the Big Day. Except then you look up and realize that your second year of med school wraps up in less than a month and your wedding dress has arrived at the salon and is awaiting its first fitting. And suddenly, these two huge events are right here, right about to happen. And it's a crazy, overwhelming feeling.

Just to be clear, I am thrilled out of my mind to be marrying Tay in less than two months. It's just that there are still many details I hope to attend to, putting the finishing touches on our ceremony and celebration. I'm also thrilled out of my mind to be finishing this year of school and moving on to clinical rotations. But Step 1 of the boards is the most important test that I will ever take (Literally. This puppy tests the entire body of knowledge from the first two years of medical training, and my score will be the most important factor in determining the strength of my candidacy for residency.) and the time remaining just doesn't seem like a fraction of what I need to tackle the entire mountain range of material, of which it currently feels like I know nothing.

But here we are. Less than two months left. It's time to stop thinking (lamenting overambitious study schedules that were left in the dust months ago and worrying about, well, all of this) and start doing. Do what I can each day and then go to bed with a clear mind so I can be well-rested enough to do what I can the next. Because the boards and our wedding are here. They're real and they are happening.

And I will be ready.

Fit for a Princess

Sometimes I see something and I decide, I have to do that. Someday, be it soon or way in the future, I'm going to do that thing!

That's exactly what I thought last year when my friend Gina told me about a race she was running, a new half-marathon in Disney World. The theme was Disney Princesses. And I knew that, someday, I needed to run that race.

Luckily for me, it actually fit into my schedule this year. Last weekend I flew down to Orlando to visit Gina and to run what turned out to be a fantastic race. Seriously, it was made for me. Why? Because the finishers' medals look like crowns with rhinestones in them. Because people all around were running in tutus and tiaras. Because on my race bib was printed not only my number, but Princess Rebecca. Because we got to run through Epcot and the Magic Kingdom, including a path right through Cinderella's castle, with trumpeters up above heralding our arrival. Because, even after minimal training and getting up at 3:45am to wait in 40-degree weather in the dark for the race to start, it reminded me how much I love to run. Oh yes, and because, when it finally did start, it was with fireworks!

Like I said, it was fantastic. I am so glad I went. And so glad I carried a camera!

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.