3rd year: CHECK!

July 5, 2015 § 10 Comments

It’s been a while since my last post and I’m starting to feel way too anxious about all the things I have yet to document. I want to write posts about my last exams and the weeks that followed, but that’s quite the project! Before that, I want to finish answering emails/comments from you – I’m working my way through them all, I promise! That’s been my plan and I will most likely get through it this week. However, life does go on and that too needs to be documented. For now I will just say that exams went well, we’re both done and so, so unbelievably happy about it!

We arrived in Bodø yesterday after a completely exhausting trip that included an 8-hour layover from midnight to 8:00 am in Copenhagen and the airline losing our bags on our stop-over in Trondheim. After lunch at Skjalg’s dad’s restaurant and dinner at Skjalg’s mom’s (grill food – perfect for 4th of July!) we crashed and ended up sleeping for almost 12 hours.

Our tiny plane from Trondheim to Bodø. Had never been on one this small before!

Our tiny plane from Trondheim to Bodø. Had never been on one this small before!!

Today has been lazy and perfect. Skjalg and I both got sunburns from coffee on the patio this morning, working on the lawn in the afternoon and a fully sunny evening hike with Skjalg’s dad. I hope it doesn’t take me too long to get used to the light here (it is light 24 hours of the day!).
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Tomorrow we start our practice in internal medicine at the local hospital. I’m extremely nervous and extremely excited at the same time. Hopefully it will go smoothly!

The courageous venture into the unknown; the persevering conquer it

June 13, 2015 § 3 Comments

Last I wrote, I was preparing to tackle the monster that is the microbiology final. How did it go? To my surprise, really well! Afterwards, I was in a bit of a state of euphoria and while in that state, decided that I could handle moving my psychology exam to that upcoming Monday (so a week earlier than originally scheduled). That meant micro on Friday, psychology on Monday and internal medicine on Tuesday. I will write more about the exams themselves in another post when I have more time and energy.

I didn’t expect to be as burned out as I was after micro. I went to the library on the Saturday following my micro exam, but my brain was as good as useless. I wasn’t really able to get any studying done until Sunday night – and that’s when I started really feeling the effects of being so burnt out. But still, I pushed through as hard as I could. On Monday night at around 20:30 I sank into a deep panic and almost made the decision to not even go to my internal exam. I’ve never done that before and honestly never would – you never, ever know what is going to happen – but that is the closest I’ve ever been. After some motivating words from my friends Jannie and Amir, I made a plan to get me through the next 12 hours. I forced myself to read through the topics once and then mark the things I needed to memorize the following morning. I ended up “sleeping” from around midnight until 3:00 am and then got up to do whatever last minute cramming I could manage. The hours after 3:00 am were probably the worst I’ve had to endure this exam period. I felt like I’d pushed my body to the absolute brink and knew I would have to pay for it later. At least the sunrise that morning was beautiful.

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The exam ended up going really well – yet another surprise! – and with that I was on my way home to collapse in bed. From Tuesday afternoon until Thursday night, I wasn’t able to get out of bed. I suffered what was probably the worst headache I’ve ever had in my life and felt like I was going to faint every time I stood up. My brain had held my body hostage for weeks and now it was time for my body to hold my brain hostage.

I’m more or less recovered now, which is great because there is still one more exam before I can fully check out! I’ve been sleeping almost 10 hours a night, plus naps during the day, and even made it to the gym for an hour of cardio this morning. My head is still quite foggy, which makes studying a little difficult. Hopefully I can push through these last few days!

As for Skjalg, he conquered patho and internal this week and has micro, genetics, surgery and psychology ahead. I still can’t believe how crazy this exam period has been! It will be so nice when it is over and we can enjoy ourselves again 😛

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Blog post title: quote by Matshona Dhliwayo

Yet again, into the fray…

June 4, 2015 § 1 Comment

Three weeks into exam period now and I’m having a hard time remembering what day it is and honestly sometimes even which month. I no longer think in proper days of the week or hours of the day. Instead, it is number of days until my exam or number of hours until one less day until my exam. Exam period is so utterly, unbelievably consuming. It’s like running a sprint for the length of a marathon.

Tomorrow afternoon I have my microbiology final. I originally had it at 8:00 am, but since I’ve been staying up quite late, I thought it would be best to push it to the afternoon. Might help to have a least a few hours of sleep. My days are monotonous and heavy. I wake up around 8, have breakfast and coffee while watching an episode of Modern Family and then I sit down to study. There are some breaks during the day, usually a 5 minute pep-talk with Skjalg or grabbing something to eat or drink. I usually hit a rough patch between 17-21, where it feels like I am running on fumes. If there is any underlying panic, this is usually when it gets fed. After, I hit a bit of a power streak that can last until somewhere between midnight and 2:00 am.

My pathophysiology final last week went surprisingly well and I promise to write more about it either tomorrow or Saturday morning. I also have probably 20 emails to respond to from some of you – I haven’t forgotten! It just takes time to read them all and write my reply and I don’t want to do it in haste.

For tomorrow’s exam, I will draw a card listing 5 topics from a total of 165 topics, divided up into 5 separate sections: (1) General Microbiology and General Bacteriology, (2) Systemic Bacteriology, (3) General and Systemic Virology, (4) General and Systemic Mycology and Parasitology and finally (5) Summary: Clinical Microbiology and Microbiological Diagnostics. If you’re curious about the topics, you can look at them here: FGM_FINALEX. By the end of tonight, I will (hopefully) have been through each topic at least once (two times for most). As always, that doesn’t feel like enough. The topics I covered last week are hardly in my memory anymore and everything feels like it is getting all jumbled together.

My positivity is starting to wane…back to the books I go. Hopefully I will have good news to report tomorrow!

I have my favorite Comptine D’un Autre été L’après-midi by Yann Tiersen on repeat to keep me company (and sane) through the night:

From Liam Nesson's movie, The Grey

From Liam Nesson’s movie, The Grey

Maybe

May 24, 2015 § 4 Comments

Sunday night and the cool night breeze flowing through the apartment carries with it the sounds of summer. It is a holiday tomorrow so the vibe in the city is that of a second chance at Saturday. Yesterday Jannie and I studied at Costa Coffee for 12 hours straight, taking a break only to meet Skjalg for a quick bite at Burrita. Today was/is an inside day for me, though it doesn’t feel like it with so much life outside.

For the past few hours, I’ve felt like I’m studying in a latin night club. There is music playing in the park and I imagine plenty of dancing to accompany it. I had planned to go and investigate a little further, but study-guilt had kept me glued to my seat.

I have two more days until my pathophysiology exam (I’m pretending only one, so that I am actually excited about the “extra day”). I’m not feeling too good about it, which is no surprise at all. I’ve had such a foggy head since pathology and have been so absolutely exhausted. Yesterday was really the first day that I was able to sit down and critically analyze and process information. I’ve been sleeping a decent amount (around 7 hours) and practicing keeping a positive mind-set, but stress still lingers in the shadows. The ferris wheel in the park changed direction today and when it did, I spent the following 30 minutes thinking I’d lost my mind. It’s been running every day for the past two or so months, from 7 in the morning until midnight or even later – and always in the same direction! It’s with me when I study and I watch its lights flicker through our curtains as I go to sleep. Seeing it spin in a different direction makes me feel like I woke up in a parallel universe. Maybe I did…

Sometimes I feel like exam period is like getting caught in a series of waves at the beach. You get pulled under and tell yourself it’s ok, you’ll surface soon, but when it goes too long you panic a little at the thought that it might not be ok, that maybe the wave will keep you under too long. Then you surface and are relieved. That was a close one, you think. Then another one comes and the same thing happens. And again, and again, depending on how many exams you have and how big they are. To keep my mood up, and I guess you could say my head above water, I’ve been listening to some of Alan Watts talks on youtube. I find his voice and words extremely calming – and so, so fitting for how I feel during all this. Sometimes his words resonate so perfectly with my thoughts, that they melt away. There is something so comforting about being reminded that you are not alone during a hard time and that your worries and fears are not unique. These are some of my favorites:

This past Wednesday, Skjalg and I met with Amir for some celebratory drinks at 360. At least we’d planned to go to 360. When we got there, we were told that they were closing because of the weather. At that point, the sky didn’t show more than some odd layered clouds with scattered dark swirls. We turned back towards Deak and ended up at Skjalg’s favorite: Boutiq’. We enjoyed some creative cocktails and then called it an early night (can’t relax too much in exam period). When we emerged, we were met with a beautiful stormy night sky. I absolutely love summer storms, so I was a little sad that we had been hidden deep inside Boutiq’ rather than front and center for the show. Luckily, I got to see some pictures. My friend Jules took these gorgeous, perfectly timed shots:

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Today, this amazing shot popped up on facebook, click here to read more about how the photo was created.

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Ok, back to studying for me. It’s already 22:00 and I still have a lot to do before bed. Wish me luck! And motivation…and a clear head! 🙂

Here’s a last little Alan Watts video, light and short but sweet and deep at the same time. It inspired the title of this post.

 

Pathology: CHECK!?

May 20, 2015 § 6 Comments

Yes, you read that right: I AM DONE WITH PATHOLOGY! I had made such peace with the idea that I was going to fail and it didn’t happen!

The exam is split up into 3 parts, two practical and one theoretical:

Part 1: Autopsy

When I entered the locker room, I was told, “We’re all getting Dr. X”. Dr. X is probably my favorite lecturer, but I had been dreading getting him at the exam because I’d heard that he really likes to drill the students. He told us in lecture once that at the final exam, we should be able to do things like group all the tumors by their color. He is extremely systematic, a feature I love in a teacher and fear in an examiner. Having a systematic method while studying is great, but being forced to be systematic on the spot, in the context of a final exam, can be difficult.

I was so resigned to having to retake the exam, that I didn’t feel nervous at all. “I’m going to go in there, give it my best and really learn from the experience,” I told myself, “then I’ll know how to prepare better the next time around.”. We were called into the autopsy room in groups of 5. Awaiting us was a similar sight: the autopsy examination table displaying the different organs. I was actually able to find photo of the room online. The picture is quite small, but at least you get an idea. Usually, there are two or three mobile metal tables with the cadavers on them in the middle.

We were each assigned an organ and I ended up getting the one I wanted the least: the urogenital complex. It includes the kidneys, the prostate and the rectum of the patient. We were allowed about 5 to 10 minutes to look over the organs and note any changes. I got a little nervous at one point but quickly calmed down and told myself to focus on the pathology and not the outcome. Dr. X called my name and asked if I was ready. Now or never!

I described the morphological changes and answered any follow-up questions he asked. The organ complex showed pyelonephritis, nephrosclerosis and cystic lesions on the kidney, benign prostatic hyperplasia (I had to explain how I knew it was hyperplasia and not carcinoma), with compensatory hypertrophy of the urinary bladder (trabeculated) and adenocarcinoma of the rectum. There were some things I fumbled on, like the term hydropyonephros, but other than that it went very smoothly and I ended up with a 4/5.

Part 2: Histology slides and Specimen

For this part, we moved on to the histology lab. The room was full with students and examiners, so I had to wait for a few minutes outside. We were only 11 English students being examined that day and maybe 30 Hungarian.

I was escorted to a computer and the technician helped me log in and open my slides. My heart dropped a little because I hadn’t reviewed the slides I ended up getting. Rather than letting that get me down, I reminded myself yet again to focus on the pathology and not the outcome. In our last histology practice, our adjunct professor told us, “We know how hard the histology is, trust me. Sometimes, we don’t even know the diagnosis when we first see it. It takes a lot of time and a lot of practice. What we want to see is that you know how to use proper histological terms to describe the changes and that you can use your pathology knowledge to properly diagnose the tissue sample”. We have covered 121 slides in these two semesters and get 2 at random at the exam. The only information we are given is which tissue the the slide came from.

I ended up with one from the colon (coincidentally adenocarcinoma, just like I’d had in the autopsy room) and one from the lymph node. When I felt I was ready, I raised my hand for one of the examiners. Once she had seated herself beside me, I began describing the tissues, first describing how the normal tissue should look, then describing the morphological changes and finally linking those changes to my diagnosis. I made sure to sort of guide her through my thought process while showing her the slide at the different magnification levels. (These are screenshots of the slides, with notes written by the fantastic Charlotte.)

For my specimen (we get 1 out of a possible 60 or so), I got this beauty: the hydatidiform mole. It’s a tumor of the cells of the placenta. When I saw it, I actually got quite excited because it meant that a new study trick of mine had worked. For the past several weeks, I have kept a google image search of whatever disease I am covering theoretically open on my screen. That way any time I look up, I have a visual association with the disease. I remember this one well because it is so creepy looking. It looks like a bunch of grapes! If you want to see another tumor with “bunch of grapes” appearance, check out the female genital tumor: sarcoma botyroides (be warned!).

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Everything went very smoothly, save for some little fumbles, and I ended up with a 4/5 for the section.

Part 3: Theory

This is the part you have to worry about. You can fail the other sections and still pass the exam, but the theory is the big one. We ended up having to wait quite a while before we were called in to our exams. I don’t think I was called until around 12:30 (and the exam started at 8:00). During that time, I tried reviewing some topics and keeping calm. I just wanted it all to be over!

I was assigned to the same examiner I’d had for the semi-final. Her topics (each of the professors have their “topics” that they are especially adept in) are hematology and oncogenes. For the semi-final, I’d struggled with my topic on oncogenes and it ended up being the reason I’d gotten a 3. That was an experience I was hoping not to repeat at this exam.

When I pulled my cards, the smile quickly dropped from my face: (A) Autosomal Dominant Diseases, (B) Oncogenes and their role in carcinogenesis, (C) Inflammation of the Trachea and Larynx. (A) and (B) were both topics that I was not looking forward to having to answer – and (B) was a serious deja vu!

For topic (A), I talked about Huntington disease and Marfan syndrome in detail and then mentioned osteogenesis imperfecta and adult-type polycystic kidney disease. She wanted me to describe the genetic alterations, pathological consequences, clinical manifestations and treatment for each and then wanted me to mention familial hypercholesterolemia and its complications.

Topic (B) was where it went downhill. This was one of those topics that I kept telling myself I needed to commit to memory, but really only superficially covered. I’ve watched videos on it, taken notes and even have a chart hanging up in my study area. Still, my brain was coming up with very little of what I should know. I tried to recall everything I could, but she was quite picky on the topic. Had I memorized this table, it would have been perfect, because this is exactly what she wanted:

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From Pathoma (board review for pathology)

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Biancafied!

 

Towards the end of this topic, she seemed pretty disappointed and said, “Ok, let’s talk about lung cancer”. My teacher is the “lung” expert among the professors, so I had no problem listing out the classification of cancers of the lung. But then she asked me about the oncogene related to adenocarcinoma of the lung. When I couldn’t answer, she got a bit upset and told me that she is sure my teacher has mentioned it before and that I should know it. This is what she was referring to:

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She shook her head, waved her hands in the air and told me that the 3rd topic would determine my grade. No pressure! Topic C was easy, but that was it’s problem…it was too easy! It’s one of those topics that feels so unimportant that you kind of jump over it. Luckily, I’d looked at it the day before. Unfortunately, it wasn’t a juicy enough topic to showcase my knowledge. Here is the topic I got plus another one just to show how much of a difference there is between them!

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My topic above, versus another respiratory topic below. Which would you prioritize? 😉

I ended up with a 3, again. I’m a 50/50 mix of excited to be done and disappointed in myself. But I’m not going to dwell on it. I worked hard, I’ve learned a lot and I have a lot to learn. These topics will be repeated over and over again during the next three years, so I will have plenty of time to get them down.

A lot of growing and self-reflection accompanied this exam and I am stronger for it. I have some improvements to make but appreciate that I have the opportunity to do so on my own time.

Skjalg’s pathophysiology exam went well, so we celebrated with some wine down by the river.

Here are some snapshots from this past week:

My study cave :D

My study cave 😀

Joshua (the teddy bear that my mom got at my baby shower - yes, he's that old!) helped me review topics. Needed someone to explain everything to ;)

Joshua (the teddy bear that my mom got at my baby shower – yes, he’s that old!) helped me review topics. Needed someone to explain everything to 😉

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Spent the last day before the exam studying outside at Starbucks

Spent the last day before the exam studying outside at Starbucks. Nice to get out every now and then!

Our celebratory wine and snacks by the river 😀

Bye, bye patho!!!

Hello, pathophysiology!

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There’s a first time for everything

May 18, 2015 § 3 Comments

It’s 22:22 on the night before my exam and I am doing something I have never done before: going to bed. Normally I stay up until the physical pain forces me to nap for half an hour and then I’m back to studying before the nausea kicks in and I go for a second nap. Then, I get up, study more, shower and head to my exam. Sounds horrible and it is, it really is. And I don’t want to do that anymore.

I am not the least bit satisfied with my knowledge for this exam. There are a lot of topics I know well, but so many that I don’t. I could force myself to stay up all night like I usually do and hope that I cover that one topic I get on my exam but this time, I’m not going to. I want to feel good about passing this class. I want to feel like I worked hard, that I really knew the material and that I deserved to pass. I want to be confident in my pathology knowledge down the line. Right now, I feel none of that. Yes, I have worked hard – I’ve probably put in at least 300 hours to patho studying this semester – but I don’t think I’ve worked smart. I can’t tell you the number of days where I have only gotten one topic done – seriously, one topic in 9 hours of studying! I tend to make things too complicated and then completely miss out on the main point.

So, I’m calling it. I’m throwing in the towel. It feels like a failure, mainly because I usually push myself to the bitter end. Then again, maybe it’s not. Maybe this is the action that will push me to change. Maybe this will help me improve my efficiency and make me a better student. At least I hope it will.

The outcome tomorrow depends greatly on which topics I will get. I both want to pass and want to fail at the same time. The desire to pass comes from me wanting to escape this feeling, the pressure of patho. The desire to fail comes from me wanting to be  forced to learn the material properly and come back when I am truly ready for the challenge. And right now, I am just so, so exhausted.

Is this me growing? Only time will tell…

The Gray Twilight

May 15, 2015 § 3 Comments

Three days out and I’m feeling both extremely calm and extremely anxious at the same time. I’m really making an effort this round to not let the stress and panic get the best of me. Last semester’s exam period was horrible and I don’t want to go through that again.

For the past hour, I’ve been holding myself back from sinking into a more negative, hopeless mindset. My eyes feel tight and dry and that makes it hard to sit here and continue reading. Sleep will come, but if I don’t feel happy with what I have accomplished before bed, negative thoughts will seep into my dreams. I can’t have that now. So, I’m trying to process it rationally.

What am I afraid of? I’m afraid of being asked something I don’t know, of standing there with my heart pounding in my chest while the examiner stares at me, waiting for my answer while I frantically search my brain for some semblance of an answer. I’m afraid of realizing that I don’t know the answer and getting caught in this endless battle of not knowing whether to admit it or just waiting until they acknowledge that I don’t without my telling them. I’m afraid of missing a major point, as a result of having spent too much time on unnecessary details. I’m afraid of saying something completely wrong. I’m afraid of feeling embarrassed, humiliated or ashamed. I’m afraid of failing this exam. I’m afraid of failing the retake and having to push all my other exams back and then failing those.

Normally, this is where I stay. I stay here, with my heart in my stomach and these thoughts swirling around in my head. I try to fight my way out with reassuring thoughts, telling myself that everything will be ok and everything will work out in the end. But those reassuring thoughts are no match for the others.

I’m changing my tactics now. Hearing that everything is going to be ok, that it all works out in the end, etc. doesn’t work for me. It’s too… aspecific. It has no foundation other than hope and I can’t work with hope during exam period. No more fighting the negative thoughts. Instead, I’m going deeper. I’m going as far down as I can go, until I reach the heart, until I reach a place where I can face them head on.

What am I afraid of? I’m afraid of failing. What does failing mean? It means that I did something wrong. And what does that tell me? It tells me that I need to change something. It is feedback and that is all it is. If I spend too much time fusing over unnecessary details and miss an important concept, then I need to learn to set the details aside and look at the bigger picture. The exam is the only place where I will get feedback on my preparation. If it is wrong, I should not feel ashamed. I can feel sad, for a moment, but then I should change and come back. I should improve and try again.

I can’t manipulate the future, I can’t figure out the perfect plan for these next three days, a plan that would ensure that I pass. I need to do what I can, what I know how to do. I need to focus on the tips our teachers have given us. I need to take it one step at a time. There is no shame in failure. Failure teaches. And that is what I am here for. The panic I feel before exams gains strength only because I think I can control the outcome. It is because I think I can do something in those few days before to make it go in my favor. What I don’t realize is that it doesn’t matter. It goes in my favor either way. If I pass, it means I prepared correctly. If I don’t, it means I have some improvements to make, improvements that will make me stronger for the next challenge. I either pass through with the armor I’ve built or build it stronger for the next round. It doesn’t need to be – and really shouldn’t be – more complicated than that. Fear and anxiety are petty emotions. Nothing comes of indulging them.

I know this from before and I’m sure I’ve written about it many times. But it is easy to forget. It is no less true for me now in third year than it was when I was in first year. I am dedicating myself to a career that is characterized by a lifetime of learning. I need to learn to be comfortable in that position. To admit when I am wrong and to learn from it. To not be afraid of vulnerability. To not feel shame when I don’t know something, but rather to feel excited at the prospect of having something new to learn. This exam is not to be feared, it is to be anticipated with great excitement. This is the foundation of medicine and I want to earn its respect. I have no doubt that I will make it through in the end because I will give it everything that I have to give. But through this all, I need to remind myself that I am a student of medicine and must learn much more than the medicine itself.

A quote I repeat to myself:  I did then what I knew how to do, now that I know better, I do better.

The competition this past Monday went better than I’d thought. I wasn’t one of the top three, but I did come in at 5th place. I spent a good few days with my mind consumed of “If only I’d…” thoughts. I finally had to throw those aside and be happy with the confirmation that I know more than I think I do. I’ll share more details about the competition itself once this exam is over. Now, it’s back to the books!

The young think that failure is the Siberian end of the line, banishment from all the living, and tend to do what I then did – which was to hide.
— James A. Baldwin

 

It’s not necessary to fear the prospect of failure but to be determined not to fail.
~ Jimmy Carter

 

You must accept that you might fail; then, if you do your best and still don’t win, at least you can be satisfied that you’ve tried. If you don’t accept failure as a possibility, you don’t set high goals, you don’t branch out, you don’t try – you don’t take the risk.
— Rosalynn Carter

 

There are no magic answers, no miraculous methods to overcome the problems we face, just the familiar ones: honest search for understanding, education, organization, action … and the kind of commitment that will persist despite the temptations of disillusionment, despite many failures and only limited successes, inspired by the hope of a brighter future.”
— Noam Chomsky

 

But there is suffering in life, and there are defeats. No one can avoid them. But it’s better to lose some of the battles in the struggles for your dreams than to be defeated without ever knowing what you’re fighting for.
— Paulo Coelho

 

Failure is instructive. The person who really thinks learns quite as much from his failures as from his successes.
— John Dewey

 

No one can defeat us unless we first defeat ourselves.
— Dwight D. Eisenhower

 

Life is to be lived, not controlled, and humanity is won by continuing to play in face of certain defeat.
– Ralph Ellison

 

No matter how hard the loss, defeat might serve as well as victory to shake the soul and let the glory out.
~ Al Gore

 

The greatest mistake a man can make is to be afraid of making one.
– Elbert Hubbard

 

Only those who dare to fail greatly can ever achieve greatly.
— Robert F. Kennedy

 

Far better it is to dare mighty things, to win glorious triumphs, even though checkered by failure, than to take rank with those poor spirits who neither enjoy nor suffer too much, because they live in the gray twilight that knows not victory nor defeat.
— Theodore Roosevelt

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