Life can only be understood backwards; but it must be lived forwards

January 31, 2016 § 10 Comments

Out of the seven exam periods we’ve survived there are three that I will always remember. Not because they were amazing, but because they challenged me to my very core and forced me to push forward when I had absolutely no hope or belief that I could. These exam periods were all, coincidentally or not, winter exam periods. I’m sure the weather and short days had a lot to do with it. Nothing stresses me out more than the end of the day in exam period. And in winter, the end of the day comes quite early.

All I can remember about the third semester exam period is anatomy. I set aside 14 days for that exam. Why? Because I knew I had neglected it during the semester (with the introduction of physiology into our curriculum, it was hard to focus on anything else). I expected that I had a lot to learn during that time, but I had no idea just how much it was. Nor did I expect how complex it all was, at least when compared to what we had previously learned in anatomy. Neuroanatomy is almost entirely theoretical, at least everything outside of the macroscopic structures of the brain and spinal cord. Learning things from scratch, understanding them and preparing yourself to present them at an oral exam is a lot to manage in a short amount of time. I was really positive when I started out studying for that exam. I had plenty of time, was excited to only have one subject to study and excited to learn something I knew I’d avoided all semester.

As the number of days dwindled, the panic started to set in. We have a guest room in our apartment that I absolutely never use. It’s mainly used as Skjalg’s office/den. The first, only, and last time I used it is while preparing for this exam. I lived there for the 7 days. I slept in the bed, used only the adjacent bathroom and emerged only to grab food and water and wave at Skjalg. In the 3 days before the exam, I developed a sort of insomnia where I could only sleep for ten minutes at a time before waking from a nightmare. The nightmare was always an exam scenario. An evil examiner, humiliating questions, forgetting how to speak, getting topics I didn’t know well enough, etc. When exam day finally came I felt hopeless and exhausted. I was 100% sure I was going to fail. What happened? Nothing. I got a kind, though demanding, examiner. I got topics I didn’t think I knew but that came forward once I calmed down and gave it some thought. I got a histology slide that I could identify right away. I had a good exam. Some mistakes, but absolutely nothing like I had imagined.

Fifth semester exam period was the next big blow. We no longer had just one or two huge classes. Instead, everything felt huge. Pathology was the monster, then pathophysiology (which included EKG analysis, which I felt so unsure of at the time), microbiology, immunology and our Hungarian final. I’m probably forgetting something, but you get the idea. This was my first time having to deal with so many large classes in what felt like such a short time. I didn’t feel confident in anything at the start of the exam period and was worried that I wouldn’t have time to properly learn anything. I spent those four to five weeks criticizing my study methods from that semester, fantasizing about ways I could improve and praying that I would make it through. So what happened? Again, nothing. I wish pathology had gone better, but otherwise all my examiners were kind, did their best to make me comfortable and to really evaluate my knowledge. I even got the “crazy, mean one” for micro. She was a little tough on me for my mistakes, but otherwise fine; she even complemented me on some points.

Then there was this exam period. I’ve matured enough that I didn’t suffer to the same degree as the ones mentioned previously. I’ve learned ways to quell the panic, or at least limit it to five minutes rather than 2 days. I’m actively working on mastering my emotional self, something I think is important to do now in medical school. This is probably the first time we are under this kind of stress and learning how to handle this version of ourselves, learning how to cope and how to act appropriately and efficiently, will be vital as doctors.

The problem with this exam period was the number of exams and the fact that I put the exams before everything else. I put them before my health, my relationships, everything. I allowed myself to be completely consumed and that is not something that can be done for such a long period of time. Reflecting on this exam period, I realize – and I mean truly realize – the importance of balance. There is no point of a victory if your mind and body are destroyed in the process, if you are not there to enjoy it in the end.

I’ve learned that I’m not good at taking breaks. To be honest, this is something I’ve always known about myself. The difference is that now I am going to do something about it. The way I’ve planned to deal with this is to do all of my “exam period cramming” during the semester. For each new exam, I start by printing out the topic list, dividing the number of topics evenly over the days I’ve set aside for the exam and then going through the topics one by one. I write my own notes, using a combination of sources, and try to finish them so that I have one day for memorization. Then, for the day before the exam, I try to memorize everything perfectly. This is where things go a little crazy. On this day I feel responsible for all of the knowledge at once. I feel as though I know nothing and that I wasted my time and should have done things differently. So, my plan now is to complete all of the note preparation for all of the subjects before exam period, maybe even a couple of weeks before, and utilize the power of spaced repetition. For exam period, my plan is to power through everything in a short amount of time. With all of the work done during the semester, I will only need to review and memorize.

This may seem like an obvious plan, something that I should have been doing all along. It is always my plan at the start of the semester to prepare notes from the topic list, but it always gets dragged out. During the semester, I feel like I become so short-sighted. I get distracted by midterms, weekly projects, research, visitors. I spend time reviewing or writing notes from lectures and not setting them up as topics. Another thing I tend to do – something I really dislike – is that I spend way too much time on one topic. For example, 1 topic during the semester may take me 10-12 hours to prepare. In exam period? I can power out 17 topics in a day. When I have the time, I spend it. So I need to be more strict with myself and exercise efficiency. In our oral exams (and most of our exams are oral), we draw a certain number of topics and have to present those topics. It makes sense then that this would be the format for note-taking during the semester! Easier said than done, I know, but I’m promising myself that this time, that’s not the case.

The best part is that my schedule this semester is AMAZING. It’s quite similar to 4th semester in that the class load is very low. I took 36 credits last semester and this semester I only have 25! I am looking so, so forward to having time to study during the week, to stress-free time at the gym, and maybe some early nights off where I can read in bed.

This is my schedule (not including research, not sure yet when that will be):

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And this is how I’ve planned out my time during the week:

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I want to be more strict with my schedule (i.e. only allowing myself to study during certain times so that my time is used more effectively) and want to spend more time studying outside of the apartment. With this schedule, I’m out at school/gym/studying for 12 hours of the day and then I’m home to relax, read, spend time with Skjalg before bed. It might make this feel like more of a job/something we do rather than being everything we are. It definitely isn’t like this for everyone. I know a lot of people that have done an excellent job balancing life and school. But for the crazies like me, this is something that needs to be worked on. I’m just happy to have the self-awareness and drive to acknowledge and change these things. Better to do it now than later.

It’s probably pretty clear that a lot of reflecting has been done this exam period and in the weeks following. It’s been the perfect amount of time between exams and the new semester, at least for this round. I’ve had enough time to relax, binge watch TV shows, organize notes, answer emails, spend time with friends, etc., but not enough time to get lazy. Over the past couple days, I’ve prepared for this first week of school. Purchases school supplies, organized my folders, downloaded lectures and notes. All of the busy work that takes time once the semester actually starts.

One of my big post-exam projects (that I’ve never completed until now): go through all the notes/papers from the last 4 years:

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All this is going to be recycled! Must be at least 4,000 pages in there:

I’m really excited for this semester. I’m excited to challenge myself to improve as a student and push my comfort zone. I’m excited to get more involved in surgery.
We’re getting closer and closer to becoming doctors now. I almost can’t believe it sometimes. It feels like just yesterday that we started…

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7th semester: check!

January 26, 2016 § 1 Comment

We’re just a little over halfway between my last exam and the start of a new semester. In the past week I’ve slept as much as possible (in my best efforts to force away the post-exam period hangover), gone on a weekend trip to Amsterdam with an amazing group of friends and done a Making of a Murderer marathon.

The last couple days before my last exam – pulmonology – were really, really tough. I’ve been going so hard for so long that I was just absolutely, completely depleted. Having to live the same day over and over and over again for weeks is a special kind of torture. Get up, sit down, study, freak out, study, coffee, study, sleep, get up, sit down, study, etc. On the Saturday night before my exam, slow streams of tears began falling from my eyes. I wasn’t scared or stressed or panicking. It was simply because I was so, so tired. The idea of having to push myself further when I felt the way I did was an impossible task in my mind. Luckily, I’ve been through this before and know some tricks to keep pushing forward. On Sunday afternoon, Skjalg sat down with me to do an amazing thing: let me explain each and every single one of the topics to him. We sat for a total of 10-11 hours and actually managed to go through all 55 topics. I don’t think I could have done it otherwise. Sometimes, being alone while you are studying is the worst thing you can do. It lets the crazy take over and slow you down!

I slept about 5 hours before that exam which, if you’ve been following me this exam period, you know is more than twice what I normally get before exams. My friend Andrea and I took an Uber up to the exam. There was a strike against Uber that started that day, so it was a bit of a stressful start to the day. Cabs were parked in the major intersections of the center and the Uber driver couldn’t get to me. Andrea had to fight him to wait for me rather than leaving me behind. Such a dramatic situation!

I’m still not used to being examined in the actual hospital. It’s such a strange feeling to pace back and forth in your suit and heels, muttering your notes under your breath Rain Man style, while sick patients and their families wait nearby. I usually try to stay as out of the way as possible. One thing about Hungarian patients in that they are generally very sweet. I remember after my internal medicine exam last semester, a patient stopped me to ask me how my exam had went. She had such a huge smile on her face and seemed so generally invested in how it had gone (she had seen me reviewing for the 2-3 hours while I was waiting). When I told her it went well, she was so happy and squeezed my hand.

My heart dropped when I read the list with the our names and our assigned examiners. I’d been assigned to the exact examiner I had absolutely hoped not to get. She is…special, to say the least. I don’t know how, but it went really well – which I was so, so happy for! On the way out, I noted that I felt nothing. No relief, no sudden burst of emotion or happiness. In my mind it was just one more down and however many more to go.

I wasn’t able to sleep when I got home, so I watched movies instead. That night, we met up with some friends at this amazing new tapas bar called Vicky Barcelona. After some amazing food and company – and several glasses of sangria – I was finally ready for my post-exam crash. I’m usually a total zombie for a few days after my last exam. I have a tearing headache, my eyes feel swollen and I have no energy to do anything. This weather doesn’t help either!

On Thursday morning, we flew out of Budapest on the 6:00 flight to Amsterdam. The trip was absolutely fantastic! Skjalg and I stayed in a charming boutique hotel along one of the canals while the rest of the group rented a 3-story apartment in the city center. I’ve never been to Amsterdam before and I have to say that I think it is my favorite out of all the cities I’ve ever been to – even in the winter! It feels like a beautiful, giant village, like you’re walking around in one of those miniature Christmas towns (which I love).

We got back early Sunday morning and decided to close out the trip with lunch at Vicky Barcelona. After that it was home to watch a movie and relax. I had no plans on napping (didn’t want to ruin my sleep) but half way through the movie, I feel asleep and didn’t wake up for another three hours!

Yesterday, Stephanie and Amir came over and we did a 12-hour Making of a Murderer marathon. It was cold and grey out, as it has been, so it was a perfect day to stay inside. I made banana bread and corn bread and we munched on some delicious Dutch cheese we brought back from Amsterdam. Life after exams is not bad at all!

I’m still not 100% recovered, so I’m going to call it a night for the blogging. I will make a post about our trip to Amsterdam and another one about my exams (for those of you who are interested in how those were). Now, I’m off to work on some of your emails!

Last stretch

January 15, 2016 § 3 Comments

Radio and derma are done and if all goes well with pulmo on Monday, I will finally be done with the 7th semester. 

At this point, I am absolutely, completely drained. I wasn’t able to sleep at all before my derma exam yesterday morning and ended up taking a 5 hour nap when I got home. Then it was up to watch The Martian with Skjalg and back to bed so I could get up early for the library. 

Since Skjalg finished Monday, I’ve been studying at the library. It’s been really nice to get out of the apartment. I think a pure month of studying at home is enough. My friends Edu and Louise have been studying there as well and it’s been such a great change to actually be social during this. We grab a coffee in the downstairs café just before noon and then head to a local French-style café for quiche and salad for lunch around 14:00.

Louise finished today, so it’s just me and Edu for this last bit. Cross your fingers for good studying this weekend and a good result on Monday! Then, I will sleep and finally answer all the emails that have poured in these past weeks 😁    

  

 

Pharma: Check!

December 15, 2015 § 2 Comments

After some heavy weeks, I’m finally done with pharma. At least for this semester. And even then, I’m not really done. It will come back during my dermatology, pulmonology and cardiology exams. It will always come back – this is medicine!

Now that it’s over, I’m really, really happy with my decision to push my exam to this week. I feel like I have a better handle on the material, a much better general overview and feel much more confident for the final exam (which we will have at the end of next semester). I would still like to add to my knowledge, but I can work on that once exams are done.

Here’s a glimpse at what my study process has been like. I feel I was more prepared for this exam than any exam so far and yet I still don’t feel completely confident in my knowledge.

I starting studying from the topic lists from the beginning of the semester and used them to prepare for each of the midterms. There are some students from previous years that have prepared notes for the topics, but I always find other people’s notes a little hard to stick to as a main source. I like to use them when I am having a hard time honing in on what needs to be covered for a certain topic, but other than that I like to make my own.

Our first midterm covered the topics in the “A” column and the second the topics in the “B” column. I decided to use the lectures as my main source for the topics in the “C” column and completed my notes about a week before I was supposed to have my exam.

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This is what the topic list I used while studying for the semi-final looks like now, after several rounds of going through the material.

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For List A, my notes were mainly charts and “quick note” pages with drug names and main points. I love taking notes on my iPad but I’ve noticed that when I’m cramming I prefer to have a hardcopy.

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For List B, my notes were almost completely based on the lecture slides. It was good in that I got a good grasp of the theory and felt like I was getting the main points.

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To add to the lecture notes, I made some mnemonic sheets for quick reference.
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I was inspired by my friend Jules to make sheets with the drug names in large font that I could pin on the wall. It was really good trick for getting some of the names in passively. Every little glance made a difference.

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For List C, my notes got a little crazy. I’d taken my first round of notes from the lectures and then brought them with me to my practical lessons. There, I would add in any details that my teacher mentioned. I got a bit frustrated with these because I felt like some of the lectures included way more information than what we needed to know (or could memorize). IMG_1779IMG_1778

During this last week, I prepared a set of mini-notes for each of the topics. I know that I struggle with whittling down a topic to “just what’s important”, so I felt that limiting myself to 1 little piece of paper would be a good exercise for me. Plus, something about holding a thin pile of mini-notes made me feel more in control ;).IMG_1770IMG_1771

Here is an example of my lecture notes + my teacher’s comments on the left, the mini-note version in the middle, and the topic I prepared for my exam on the right.

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Lastly, here are the notes from today’s exam. They were topics that I really didn’t feel very strong about – especially the epilepsy topic – but I’m happy I was able to recall what I did. My exam was supposed to start at 10:30, but I didn’t go in until around 12:30. I even went to school early because I was too nervous to review at home. That meant 4 hours of stress-ridden review time before.

The exam took place in my teacher’s office. It was a small room with a desk along the window and a couch and two large sofa chairs surrounding a low coffee table. There was enough room for 3 students at a time, one being examined and the other two busy writing their notes. It’s a bit of an awkward situation to sit there in such a social setting while being examined, but there’s a comfort knowing that we all go through it.

During the exam, I blanked on some really simple things (like indications of beta blockers, other than arrhythmias and hypertension). That’s one of those things that you hop over while you’re studying because it’s just “so easy” and then you can’t find it in your head when you need to. Luckily, I was able to recall it with some help, but it was still pretty embarrassing. My teacher is a really friendly guy who loves teaching, but he also wants us to know the material – and know it well! He asks a lot of questions and is quite demanding. IMG_1785At the end, he motioned to the other girl in the room (she had finished her exam already, but stayed as a “witness of fairness” as is done in most exams) and said, “If she was heading up from a 3 to a 4, then you were heading down to a 4 from a 5. Oh, Bianca, Bianca.” He sat in thought for a few moments and finally said, “Ok, I’m going to give you a 5, but with a little side note: needs improvement.” I joked that I was on probation and would make sure to be better next semester. We are examined by our own teachers for the semi-final, but at the final exam, we are examined by one of the other professors.

I got home around 13:30, ate and then crashed for a couple of hours. Now I’m off to bed, with sweet dreams of my weak, probationary 5, so that I can wake up fresh and ready to cram for Saturday’s surgery exam. Will be easier knowing that I have this monster one behind me!

P.S. I have a FitBit (an activity monitor) that measures my heart rate throughout the day. When I looked at it this afternoon, I burst out laughing. Check out my heart rate this morning! Me? Nervous? 😀

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The back of the medal

December 8, 2015 § 9 Comments

Yesterday, I received an email from a new doctor in England whose brother is a 2nd year student here at Semmelweis. She was curious about exams here, about the demand placed on us, and said that it seemed more difficult than her studies in England. 

I received it at a funny moment. I was in the middle of crying over my notes and being so thankful that they were in plastic sheet covers. What a coincidence that I should come across this photo this morning:

I don’t consider myself to be a very emotional person (generally). The only time you’ll see me cry is while listening to certain songs or watching movies; usually ones that touch on mortality (like About Time). I AM a perfectionist. Though I’d like to think I’m a recovering perfectionist, if there is such a thing. I’m also, as my mom once wrote in one of my birthday cards, “intolerant of inadequacy and incompetency”. She wrote that after a story about how I freaked out on a plane one time because my younger brother Christian was coloring outside of the lines in his coloring book. On top of this, I demand a lot from myself. I set impossible goals and when I don’t make them, I get really upset with myself. Studying medicine seems like the perfect fit, right? The perfectionist and the infinite subject.

I know it seems that I’ve gone off on a bit of a tangent (or five), ones detailing quite personal things about me, but I promise they all feed into a point. 

Exam period is hard. That’s nothing new. I’ve written about it many times before. However, I usually write when I feel a spurt of inspiration, sort of as a means to motivate myself through the hell of the moment. I may convey that I’m stressed, that I’m nervous, that I don’t know if I can do it. 

When I read that email, I felt so connected to her brother. It’s so easy to isolate yourself in moments of weakeness, to feel like you are the only one feeling what you are feeling. I usually add on to it by thinking that everyone else is doing fine and that is just me that can’t handle my emotions.

I started to wonder if that comes across in the posts that I write during exam periods; these specific chunks of the year where I am a full-blown emotional wrek. It’s not that I want to portray weakness or that anyone really needs to witness this wholly irrational version of myself, but more that connection; that moment where suddenly you feel normal and truly believe, even if only for a second, that everything is going to be ok. Sometimes Skjalg will joke around with me and say, “Buda-B doesn’t get scared” or “Buda-B doesn’t back down”. If I’m seen as super strong or if people are under the impression that I always have control, I’m flattered, but that’s just not the truth. 

Let’s take a look at the ugly truth. This morning I was supposed to have my semi-final in pharmacology. I’ve been studying well (or so I thought) through the semester. I finished my notes for the topics last week. I started reviewing the topics we’d covered at the beginning of the semester. I started building my wall of insanity:  

   
But pharmacology is memorization. And for some reason, I hit a total block. I started obsessing over some topics, not trusting my notes, searching through 20 different sources saying slightly different versions of the same thing. As time passed, I started to panic. I was spending 3 hours memorizing 1 topic. I calculated that if I somehow brought that down to 20 minutes per topic, that would still mean 16 straight hours of memorization. 

Yesterday, I got 2 topics done in 9 hours. I felt hot and cold, exhausted and overstimulated, motivated and depressed, and I could feel my entire circulatory system throbbing in my body. Tears left me dead by 22:00, so I decided to call it a night and wake-up at 3:00 to continue; to salvage what little chance I had left. What happened? I started studying, but got only half a topic down in the first hour and a half. I felt nauseous but decided to force down some food. Then I distracted myself with some YouTube videos while I ate. Then I started thinking about all the topics I couldn’t answer. All of them. At the same time. Into the shower I went, hoping that the steam would someone distract me from my hyperventilation. It didn’t help. I can’t do this, I thought to myself, I really, really can’t do this. 

There were still 40 minutes before Skjalg’s alarm was supposed to go off. No way I was waking him up before then. So I got into bed and stared at the dark ceiling while observing the stress race through my body. 

When his alarm went off at 7:00, I leaned in and said, “Hey, I don’t think I’m going to go today.” He responded with a simple “ok” and lay with his eyes closed for a few more moments. “Why not?” he asked. I began to explain that I really, truly wasn’t ready, that I didn’t want to go and get lucky on my topics, that I wanted to learn it properly so that I know it long term and not just for now. “I think that sounds like a good idea,” he said, eyes still closed. With that, I started sobbing. I felt such a sense of relief that he supported my decision. I was so scared that it was a hasty decision being made out of fear, that it wasn’t rational in any sense, that I was just succumbing to weakness. 

That’s just it: we are complete messes in exam period. Some of us lay on the floor and stare at the ceiling for hours without almost so much as blinking. Some of us sneak out to the corner store and literally jump at the site of another human being. Some of us cry about anything and everything. Some of us are complete roller coasters. And some of us are like a storm, calm in the beginning, but with a dark strength that grows larger and larger until the storm hits. That’s me. 

I hope you’re still following me at this point. It’s been a long, long day. I made a really tough decision that feels like a really strong decision made in a really weak moment…one that my brain is still trying to define as weak. My thoughts are scattered, my eyes are throbbing and I should be sleeping so I can get up early to review for tomorrow’s surgery exam. 

So why did I write this? Because I wanted to show that there is a side that doesn’t get published. That no one likes to talk about. That many would say shouldn’t be talked about. That the weak moments are there and sometimes they are the only thing we know. And yet, we keep pushing forward. Exam after exam. Semester after semester. And we can feel so alone while we do it. We can be so quick to think that everyone else has it so easy while we have it so hard. I don’t want people who read my blog to think that I always have everything figured out. That I don’t go through tough moments. I do and I know them very, very well. But there is such a beauty in that weakness. Not during, of course, but after. Smooth seas do not make skillful sailors. 

As I lay in bed this morning, in a pool of my tears on Skjalg’s chest, I gave him one of the most heartfelt “thank yous” I’ve ever given. “It’s ok baby, it’s the back of the medal”. I’ve never heard that expression before and hearing it then in that moment that fit is so perfectly, I couldn’t help but smile. It’s so easy to feel isolated, especially with social media being what it is today. You compare yourself and your life to everyone’s highlight reels. You only see what others want you to see. So, I wanted to share with you a glimpse of the “back of the medal”. A side Skjalg knows all too well. A side that we are probably all too familiar with in some way or another. 

  

This is fine

December 7, 2015 § Leave a comment

This is my 300th post and while I had been hoping to write something profound and reflective, I am as far from that mindset as possible. Instead, I will leave you with two photos. A picture is worth a thousand words, right?

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