My Happiness Project

Some of the best books I have read have been purchased in airport convenience stores prior to taking a flight (my favorite of these: The Book Thief by Markus Zusak). Three days ago, I came back from a trip to Puerto Rico with my husband and bought The Happiness Project by Gretchen Rubin about the author spending a year working on little goals each month to have an overall more happy life. It truly resonates with me, as a person who feels like I have a wonderful life on paper and wants to enjoy it more. It inspired me to get back into writing, something I actually love to do and should carve out time for.

Since my last major blog post, a lot has happened. I matched to my #1 Family Medicine residency pick at Fort Belvoir Community Hospital in Virginia. I bought my first home. I got married. I graduated medical school and have finished the majority of intern year. With my Step 3 board exam behind me and three rotations ahead of me, I am on my way to being somewhat legitimate when it comes to a career as a physician.

The further along I get, the more I appreciate what I have done to get where I am today and the more I wish I picked another career path. In fourth year of medical school, I really lived it up. I found ways to love medicine again – most notably, by teaching. I was a a teaching assistant for anatomy and took a four-week Medical Education rotation with weekly lectures on how to teach and hands-on hours in the classroom. It was something challenging that exercised my brain power, honed my confidence in my medical knowledge/skills, and allowed me to work with medical students. It made me feel like there was a way to find myself again in this career I chose 10 years ago.

I realized practicing clinical medicine doesn’t always bring me joy. There are beautiful moments. There are times I feel energized. There are patients who make me forget my qualms about pursuing a career in medicine. I love working to improve someone’s quality of life. I have purpose.

I feel constantly validated when it comes to my career choice – alas, there are worse things to have chosen in life than to become a doctor. At the same time, I think every day about what I plan to do in 10 years. Who I plan to be…in 10 years.

An educator.
A Zumba instructor.
A writer. A novelist.
A traveler.
A full-time mother.

Then I wonder to myself: why not do what I want to do now? What is stopping me? Well, time. That I can’t necessarily change. I can optimize my use of time but I can’t help how many hours I am scheduled to work in a given week.

Besides time, I realized the other thing stopping me from doing what I want is energy. I simply lost the will and intrinsic motivation to do things that bring me happiness that involve any mental or physical energy. All the energy I have goes to work, sleep, eating, and making important social functions.

This past week – my first week off during intern year, mind you – I found my energy again. I cleaned my house. I slept 12 hours a night. I spent time with friends and family. I walked over 20,000 steps a day exploring another country. I went to a wedding. I found a part of me again that I had neglected – that part of me that felt like the Authentic Afsoon. Or at least, the Afsoon I am more proud to be. Kind, active, considerate, less anxious, engaged, spontaneous. I read for fun. I mapped out my future novel in my head. I laughed loudly. My husband reminded me that I have a goofy sense of humor and that I find positive energy in what’s around me.

In reading the first half of The Happiness Project I tapped into a part of myself that makes me appreciate who I am apart from work. I think my own personal source of happiness is finding self-worth and enjoyment in life separate from patient care and my career in medicine. Ultimately, my perfect career in medicine would be a couple half days of clinic a week while primarily teaching. And writing. And I’m not talking writing research articles or academia. I am talking good old-fashioned short stories and novels. Memoirs. Historical fiction. The occasional poem. Some inspired by medicine, others not at all.

I am tired of looking to 10 years from now for an idealistic notion of what career will elicit the most happiness. In the now (for the most part), I adore my faculty, my co-residents, my nurses, my support staff, and many of my patients. I have a healthy marriage, a great relationship with my family members, and multiple close friends who are basically family. Although I spend the majority of my hours at work, I no longer wish my job to define me – something I think most people in the world probably relate to. Not sure how often we find that in medical residents.

I am setting out on my own personal Happiness Project. One that involves tapping into what truly brings me joy, and doing more of that whenever I can. Sure, I love Netflix, movies, couch time, snuggling with my husband, drinking a warm cup of tea. I also love cold lemon water, exotic fruits, warm sunny days, outdoor trails, window shopping, the smell of new books, Zumba, circuit training, ice skating, puzzles, writing, doing projects around my house, organizing, updating my excel spreadsheet to analyze my finances, talking to people I care about, browsing houses for sale, NPR, and nothingness (sitting by myself, thinking about nothing, letting my mind relax and be free – some might call it meditation).

I want to be my authentic self at work, at home, in the real world. If that makes people define me as neurotic, anxious, kind, loving, hardworking, Type A, whatever – I give zero shits. I am done trying to be the best person. Nobody likes a perfectionist. I am Afsoon – whoever she is. I have an impressive range of emotions. I appreciate different types of people with a wide array of interests. I have a wonderful life. I regret my career choice (which apparently many interns do) and have found a long-term plan I am comfortable with. I am happy that by doing this career, my husband was able to pursue his dream of opening a music school and becoming a full-time musician. I am happy I picked Family Medicine and especially grateful that Fort Belvoir picked me back. Even if I stopped writing for the past year, I am a writer. I appreciate the power of words on paper. I am home, in Virginia, surrounded by family and my closest friends.

I think the most crucial aspect to my personal happiness project is acknowledging my mood for whatever it is, validating it, and using what energy and time I have to do something that brings me joy. We only have so many moments in our time on earth. I choose to spend mine being an authentic person and doing good. Whatever that means for the future, I need to live in the present.

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Authenticity

Authenticity
Hides behind pictures on a screen,
Beyond words on paper.

You can hear her between statements,
In a sigh,
In a laugh,
With wrinkles around the eyes.

You can see her when you aren’t looking,
When you aren’t thinking,
When you weren’t asking.
You might not notice.

She can explode.
A question,
A hug,
A check-in –
Triggers.

Authenticity –
She’s where happiness lives.
Devoid of mask or cloak.
Free from expectations,
From self and others.

She is true.
Feared for her candor,
Perceived as aggression,
She is still loving,
And strong.

Major Life Decisions On The Road

When I originally started writing this blog post, I went into excruciating depth about my inner turmoil deciding between psychiatry and family medicine – about the uncertainty, anxiety, insomnia, and my appreciation for both fields. Deciding between the two was truly a win-win situation, and I think anyone can understand how difficult it is to think you are going down one path for ten years only to realize you prefer something else along the way. An hour-long stroll along the Riverwalk in San Antonio at 98 degrees can help with introspective thought and major life decisions…just make sure you have a water bottle and snow cone handy. The teaching point is that I always need to remain open-minded and flexible to new opportunities, because I am truly grateful for changing my career course.

Since my last post, I alternated rotations in psychiatry and family medicine. I wrote a book chapter on childhood-onset schizophrenia for my capstone project, rotated at Fort Belvoir for family medicine, rotated at San Antonio Military Medical Center for psychiatry, and realized that family medicine is the better fit for my personality and career goals. I quickly changed my rotation schedule around to allow for time at Scott Air Force Base (AFB) and Eglin AFB to check out two more locations for family medicine. It has been a fantastic 14 weeks thus far rotating in psychiatry and family medicine, and I am beyond excited for a career in family medicine in the military. Thank you to all of the wonderful people I spent the last few rotations with!

Sometimes, I find myself grieving for what I’ll miss about psychiatry – long appointment times with patients, neurophysiology of psychiatric conditions, and treating thought disorders. Bright side, I will see plenty of behavioral health in family medicine and get the full latitude of primary medical health care. I enjoy diverse chief complaints and having a broad scope of knowledge. I love learning something new with nearly every patient encounter, even when the presenting problem seems entirely straightforward. Family medicine challenges my mind, keeps me engaged, and managed to warp the culture of medicine to a positive learning environment focused on patient care.

Time keeps flying by, and the rumors are true that fourth-year medical school is a wonderful year compared to third-year. I have gotten involved in way too many activities and projects, am planning vacations/weekend adventures galore, and am looking forward to wintertime when I will take a break from traveling and enjoy my time at home. I have been in 15 states since April with a successful road trip to Florida this past weekend (Hurricane Irma decided to stay out of my way!). Cheers to making major life decisions! T minus 3 months until I know where Andrew and I will be for the next 3 years!

Step 1 Study Period: My Approach

If you are not studying for step 1, I’d just skip this post altogether. This is for the Googlers out there who magically find their way to my blog. I don’t feel comfortable publicly posting my score, but I will tell you it was good by any specialty’s standard.

Before I started studying, USUHS had us do an NBME pretest that I beyond failed and had zero correlation to my score. Quite demoralizing to hear people say “oh you typically improve 10-30 points from your first NBME test” when that would range from “still failing” to “oh good I hit 200.” I think 228-230 is average for the exam, so I was originally shooting for above 230 (which is probably a typical goal). I don’t suggest doing a diagnostic test prior to studying because it will likely only freak you out. If you’ve been actively studying for step 1 prior to your dedicated study period, a diagnostic might be a good idea to see where you are at.

As an FYI, USUHS does Step 1 after a year of core hospital rotations. Although it makes us further from the basic science stuff (killer when it came to relearning microbiology and neuroscience in particular), it made the clinical vignettes much simpler to understand. Pharmacology, a sore subject in pre-clerkship, became pretty straightforward after working in the hospital. I personally found it to be an advantage.

For studying, I cut out ALL social engagements. They tend to stress me out when I need to focus, and I am a happy camper doing solo activities. I would typically wake up around 9am. Sometimes I worked out in the morning and had a late start to studying (as late as noonish). I went systematically through organ systems and covered an organ system a day. I would read a chapter in First Aid, do the corresponding questions in UWorld (tutor mode), and watch the Pathoma lecture while taking notes in my book. Most organ systems could be done in a day. Cardiology and Heme/Onc needed ~2-3 days and Neurology needed ~3-4 (for me). I personally bought a fresh copy of First Aid 2017. My First Aid 2014 had notes all over it that I found either too detailed for step 1 or too basic for the level of comprehension I had reached. I tagged pages that I wanted to make sure to review again. I did one full round of UWorld and completed a chunk of the questions I got incorrect (it’s easier seeing them a second time but super frustrating to get them wrong again!).

I cooked and cleaned pretty frequently. Andrew and I would have dinner when he’d come home from work, and we’d usually watch a TV show or movie before I would get some last bit of studying done before bed. I slept a TON… like 9-12 hours a night. I can function really well if I sleep a lot, though it was probably secondary to pathologic sleep deprivation I had throughout the previous year of rotations. My study period was 5 weeks long with really 4 weeks of truly focused study time. The first week I maintained some social semblance and realized it was impossible for me to be productive. I only had a few days in the first week where I did practice problems casually and perused First Aid a little.

I did the two UWorld assessments one and two weeks before my test day and thought they were really helpful (though I panicked because people kept telling me that I would likely do 10-15 points worse on my real exam based on the uworld scaling compared to NBME). I got the same score on both assessments and ended up with 13 points higher on my real step 1 score. I personally didn’t want to pay extra for the official NBME practice exams online, especially without getting answer keys, but I have heard from many that they found it useful to get comparative test scores. Keep in mind though, I tend to test well – I am pretty calm during exams. On test day itself, I took a minute break between sections just to close my eyes and breath. I forced myself to take 25 minutes for lunch. The exam day felt shorter than I anticipated because I thought it would last forever. The nice thing is most test locations let you start early.

My grand advice is:
– Make a study plan. I felt like 5 weeks was perfect timing to include my first week of figuring the system out.
– Figure out your resources (mine were UWorld, First Aid, and Pathoma). Don’t use too many.
– Don’t be too hard on yourself if you are behind schedule. It’s inevitable. Plan your schedule like you have one less week than you really do.
– Give yourself frequent breaks!
– Don’t let yourself burn out. Schedule entire days off!

Studying for Step 1 is uber stressful but it can also be really nice to make your own schedule for once, wear pajamas all day, and be your own boss. Enjoy the perks!

Humanistic Care in Medical School

I do solemnly swear, by whatever each of us holds most sacred…

Medical students conclude their white coat ceremonies by reciting the Hippocratic Oath – at least, a modern and truncated form of the oath. The Hippocratic Oath symbolizes the essence of health care: a covenant between healthcare practitioners and the patients they serve. This is a sacred relationship. Patients submit to another human being, oftentimes a stranger, to heal their physical and mental ailments. Physicians reciprocate by honoring patient autonomy, justice, beneficence, and non-maleficence. Ultimately, I am now part of a community of physicians dedicated to patient healing and medical ethics.

That I will be loyal to the Profession of Medicine and just and generous to its members…

I began the first year and a half of medical school building my knowledge base. My classmates and I were getting assimilated to the community and admired our faculty members for directing our education. I saw my first ‘patient’ on the second day of medical school. It was an assignment to meet a child with autism spectrum disorder at the patient’s home. He was a brilliant teenager who struggled with social skills and emotional intelligence. He told me he had great aspirations and planned to apply to my alma mater, William and Mary. We bonded about this common interest and discussed the challenges he faced and the therapies he found beneficial. The first patient encounter of medical school was an important one; I learned that my patients teach me just as much as I can teach them.

That I will lead my life and practice my art in uprightness and honor…

My attraction to the art of medicine is the pain of the human condition and my role in its healing. I act according to what I believe is right and what the patients believe is right, serving patients to the best of my ability. Patients deserve respect and autonomy throughout this process; the patient role is one that can be vulnerable, or one that is empowered with the support of good healthcare providers.

That into whatsoever house I will enter: it shall be for the good of the sick to the utmost of my power, my holding myself far aloof from wrong, from corruption, from the tempting of others to vice…

There are certainly days that make me question whether the pursuit of medicine is worth the time, energy, and sanity. Medicine is a grueling career path, one that challenges my physical ability to stay awake, my mental ability to stay focused, and my emotional ability to stay engaged in my personal life. Enthusiasm wanes with burn-out. I understand how physicians can lose their heart (i.e. humanity) when treating countless patients, who become diagnoses rather than human beings. In those times when humanity wanes, I must stay grounded to the reasons I pursued this career path to begin with: my relationship with the patient and my dedication to healing. I enjoy supporting my community – at the hospital, in their homes, outside healthcare settings; at the same time, I am uplifted by my colleagues and patients on a daily basis.

That I will exercise my art solely for the cure of my patients, and will give no drug, perform no operation for a criminal purpose, even if solicited; far less suggest it…

I remember my first patient who died. I had been following an 85-year-old gentleman on the medicine ward. He was transferred from the ICU after a remarkable degree of recovery from a stroke complicated by intracranial hemorrhage after administration of tPA. Refusing feeding tubes, my patient was unable to swallow and aspirated on food or water with any meal he would take. He became progressively hypernatremic. This was my first patient with overt delirium, falling in and out of lucid states. He refused water, was a difficult ‘stick’, and would pull out IVs overnight even when he had family or a 1:1 sitter. I sat in with him and his family for numerous discussions. I became the main contact for my patient and his family, with the support of my residents and attending.

The patient told his daughters that he was ready to die. I held one of his daughter’s hands as she walked away from her dad crying. His family feared hospice but finally agreed that home hospice would be ideal for him, as he preferred to die at home. The last time I saw him was Friday – the last day of my inpatient Internal Medicine rotation. He told me, “I want to go outside.” I told him, “We are getting you home. You will finally get to go outside.” I got a phone call Sunday that he died at 10am, two hours before the ambulance was scheduled to take him home. My heart fell apart. I was attending my grandfather’s funeral that day and felt overwhelmed by the fragility of life. At the same time, I felt the need to celebrate the lives of two wonderful men who left behind families and friends who loved them.

That whatsoever I shall see or hear of the lives of my patients which is not fitting to be spoken, I will keep inviolably secret…

As a medical student, I have the opportunity to sit by my patients’ beds, speak with them (sometimes for hours when there was time), and learn their life stories. Being a healthcare worker is a privilege, one that I will continue to honor by valuing what my patients tell me and serving as their advocate. By learning about my patients, I gain respect for who they are as people and how that can affect their medical decisions. Part of being a physician is allowing the patient to guide treatment therapies to attain the best possible medical outcome. This journey is one that optimizes their values with respect to religion, culture, upbringing, and circumstance.

These things do I swear. Let each of us bow the head in sign of acquiescence…

I define myself by my academic contributions, compassion for people, and by my desire to change the world for the better. I want to be a doctor, but I am only beginning to understand what that entails. I am learning about pain of the human condition and what I can do to promote its healing. I am learning what it means to do what I can to help my patients and to let go of what I cannot control. I am learning to appreciate the good moments when my patients experience recovery and to reflect when it comes to poor patient outcomes. I aspire to be a physician who heals my patients – not just with my knowledge – but with a love for mankind and compassion for others that motivate me to serve my community.

And now, if I will be true to this, my oath, may good repute ever be mine.

The Life of an MS3: Good Times and Good Riddance

USUHS fourth-years are officially done with classes/hospital rotations and have graduated this past weekend. So concludes the third year of my medical school career. Cheers to that!

My existential crisis [see last post], though ongoing, has abated in intensity. I have accepted my fate as a physician despite the occasional fantasies of retiring to a small town by the water, becoming a fiction novelist, and traveling countryside in an RV with Andrew. I signed up as the newsletter writer in Alpha Omega Alpha (AOA), so I will consider that my attempt to bridge between the worlds of medicine and humanities. It’s the little things, my friends, that keep you going.

I have lots of updates for the past year, and I will try to keep them brief. Last post, I talked about how pediatrics restored my faith in my career in medicine. That was a wonderful rotation (shout-out to Walter Reed’s pediatrics department and their fantastic program!). The entirety of the rotation, I reevaluated my life and thought, “Man, I should be a pediatrician.” Then followed Family Medicine in Offutt Air Force Base. Yes, folks. That is in Omaha, Nebraska. I have finally ventured to the real Midwest. I was lucky to go during the summertime with a lovely classmate and had the best rotation of medical school – a much-needed escape from life’s obligations at home. I learned that I love primary care and appreciate the family medicine physician mentality. For the first time on rotations, I truly felt like I fit in.

As the five weeks in Omaha continued, I saw the perks of family medicine – especially in the military. The options are endless. I can do primary care in adults AND children. My experience in pediatrics helped facilitate more positive experiences with children. Fun fact: I had never picked up a baby prior to my pediatrics rotation at Walter Reed. Now I am a diaper-changing professional. Anywho, the physicians I worked with in Omaha were fantastic. I fell in love with the field. I felt at home. Considering I always intended to be a psychiatrist, I also became very confused.

Next up, my elective! I chose addiction/substance abuse at Fort Belvoir, VA working in both inpatient rehabilitation of active duty members and in outpatient psychiatry with a methadone clinic. What a great experience where I felt involved in understanding the epidemic of addition in our nation. I worked with fantastic psychiatrists that made me feel at home in their field, despite the fact I hadn’t even rotated in my core psychiatry clerkship yet. One resident made it his mission to reaffirm my decision to pursue psychiatry considering my recent interest in family medicine. During the rotation, I definitely felt like I wanted to be a psychiatrist again (ie positive experience).

The theme of wanting to do the field I was rotating in continued (which I hear is common for those interested in family medicine). I really enjoyed my internal medicine rotation, especially the inpatient experience where I had the opportunity to work with residents and attendings who were dedicated to my betterment as a student. So much knowledge to be had. I was nerding out. Internists are definitely the Ravenclaws of medicine [Side tangent: that would make Surgery the Slytherins, Family Medicine the Gryffindors, and Pediatricians the Hufflepuffs… I need to figure out how to fit in the other specialties].

My last rotation of 2016 was psychiatry. Naturally, I was doing exactly what I wanted to be doing for my life but at a medical student level. I felt challenged and never experienced the “psych-ation” hours some students enjoy on their core clerkship. I had hoped that it would help clarify psychiatry vs. family medicine for me, but it actually made me more confused. I love psychiatry, but maybe I also love family medicine. How can I do both? I have been looking into joint residencies – there used to be an Air Force option to do family medicine/psychiatry at Andrews AFB way back. There is currently an internal medicine/psychiatry residency (5 years as opposed to the 3 years in medicine and 4 years in psychiatry) offered to Army, Navy, and Public Health Service. Unfortunately, a double-boarded position is not currently in the needs of the Air Force right now, but I am trying to sell it [wish me luck, folks]. 

So that is how I concluded my 2016 year of core clerkships (typically done during third-year for other medical schools). I am still unsure about what I want to do for my specialty, and I approached my schedule so that both psychiatry and family medicine remain on the table. 

Over winter break, I got engaged (hollaaaa) to the love of my life while on vacation in Dominican Republic. It was a beautiful trip with us and a childhood friend of mine (the one who I credit with our relationship because Andrew was originally her friend from college). We met some great people while we were there and are developing an international friend pool, which is a good deal for future travels. 

Winter break went straight into Step 1 study time. We take it later than other medical schools to make up for the fact we start in the hospital 6 months earlier. Not much to say there because not much happened. My score was pretty awesome, and I think it is because I chose to CHILL OUT for once, minus the occasional panics about how I was behind schedule and felt like I was going to fail. In case there are pre-step 1ers reading this, I’ll lay out my study plan in another post.

After Step 1, it was back to the classroom after over a year. We had 6 weeks of trainings and additional education on certain clinical topics. We got certified in BLS (basic life support), ACLS (advanced cardiac life support), and ATLS (advanced trauma life support), when only BLS is required for medical students. We had a fun military event called Gunpowder that’s a prelude to Bushmaster in September where we do military medicine scenarios like making a rope bridge to get a patient across the river, running codes, and climbing walls (or in my case, having someone help push you over a wall). My team consisted of a group of classmates I had never spoken with before, and we worked great together – made it in third place among 16 teams!

Despite the training, I felt rusty on my hospital skills and was anxious to go back. Day 1 back in the hospital was on my birthday at Madigan Army Medical Center at Fort Lewis-McChord in Washington state. Neurology was a great transition rotation because we acted as the inpatient consultation service, so I felt like I was relearning all of medicine despite our focus on neurology. I also felt like so many things were finally clicking from basic science neuroscience to clinical practice. Neurologists are definitely friendly, love what they do, and have a good lifestyle. The brain is cool, friends. I don’t understand how neurology isn’t a more competitive field!

Washington was good to me. The lodging was comfortable. My residents were awesome. My USUHS classmates were fantastic, and I met some friendly HPSPers. A couple USU folks and I traveled on weekends – to Seattle, Portland, Crystal Mountain, and Tacoma. What a beautiful state! Despite all the rain, the sun managed to shine bright on weekends.

Although I had a great time on neurology, it was nice to come home, reunite with friends and family, and NOT have homework anymore. FYI to non-USUHS folks, neurology entails 10 papers, 1 take-home quiz, and a final exam. Fun stuff.

I am currently on ophthalmology where the surgeons are happy, and I am trying to get used to a new routine. I became re-engaged in group organizations after being welcomed into Alphi Omega Alpha and the Gold Humanism Honor Societies. I am working on a curriculum project with school and have two research projects going at the same time. I am also trying to get in shape for the wedding. So it has been pretty busy since I’ve come back home. Andrew and I had an epic engagement party with local friends/family this past weekend where his family was exposed to the beautiful wonders of Persian dining. With those wonderful memories and my social quota reached, it’s time to get busy. I have a book chapter due on June 1 and my step 2 CK on June 7. Cannot say I have been studying too much for this one…so I’ll let you know what my study plan is after I figure it out myself!

Surprised you’re still reading. It’s been quite the year, so I appreciate your time as I share my experiences 🙂

The Existential Crisis of a Second Year Medical Student

As someone who never intended to be a doctor growing up, I struggle with this crossroads at times where I am losing the side of myself I find most precious and dear. I worry about losing the girl who loves creative writing, reading fiction, watching political discussions, and contemplating the philosophical complexities of humanity and how we fit into this strange world.

My interests go far and are certainly not limited to science or medicine. I could have chosen many professions, but of them all, I most preferred becoming a doctor. Perhaps my reasons are the same as others, for the cliché reasons of wanting to help my patients. And I find the functioning of the human body amazing. Studying medicine is useful both in practice and in my own life. Mostly though – I am inspired by the pain of the human condition and how I can play a part in using my knowledge to take that pain away.

I began the second year of medical school feeling confident in my abilities as a student. I excelled academically and knew how to study for exams. Reproduction and Endocrinology Module set me off on a good start for second year and certainly helped for my first rotation in Ob/Gyn. Multisystems Module felt like the academic time to tie up loose ends, build on previous concepts, and reminded me that microbiology is more complicated than I realized. I had a great run and ended up with a distinguished performance award for pre-clerkship didactics. The first year and half of my medical school career were some of the best times of my life. I figured out a routine and thoroughly enjoyed my free time. I stayed close with friends and family and got to spend time in my favorite area (northern Virginia ie home).

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Jessie and I at her wedding!

My last real break this past winter felt like more work. I spent the majority of my time packing my entire apartment into storage amidst construction due to a flooding/molding issue and catching up with friends in the area before heading out to San Diego for rotations. I spent a few days in Sacramento (Andrew’s first trip to California!) for Jessie’s wedding – first time I was a bridesmaid. I learned about how American weddings normally go and got to wear a beautiful dress and take part in their beautiful wedding. Jessie and Andrew (her husband is also named Andrew) had a lovely ceremony and amazing New Year’s wedding party.

USUHS is unique in that we go out on rotations halfway through our second year of medical school and postpone Step 1 exams until after our “clerkship” rotations (Ob/Gyn, Surgery, Pediatrics, Family Medicine, Internal Medicine, Psychiatry, and an elective). 3.5 months in San Diego for Ob/Gyn and Surgery was the longest time I have been away from Virginia.

The first few weeks of Ob/Gyn, I was insanely enthusiastic and enjoying learning. As the days continued, I began feeling the enthusiasm wane a little as my days consistently dragged longer, as I was missing home, as I felt like I was never good enough. Being a medical student at a teaching hospital is being at the bottom of the totem pole. Some doctors want to help you climb up and others will stand on you and ignore you. Ob/Gyn in San Diego consisted of 5 weeks: complicated obstetrics, labor and delivery, reproductive endocrinology and infertility, gynecology, and oncology. I loved getting a taste of everything, but it was exhausting switching teams weekly. As soon as I felt comfortable, I had to start all over. The program director was amazing and the experience was great to start out with as Ob/Gyn exposed us to the wards, surgery, and clinic.

The next 10 weeks were surgical rotations: cardiothoracic surgery (I held a heart – it was cool), ENT (great life experience), and general surgery. My existential crisis pretty much compounded itself during surgery when I began questioning whether I fit into medicine as a culture. I enjoyed my weekend trauma shifts, met inspiring people, and did awesome things in the OR. Something just didn’t click though.

During my time in San Diego, a beautiful friend of mine from college took her life. I think about her in waves of mixed emotions, and sometimes I find myself falling apart at the thought of the world losing such a lovely person. It got me questioning the purpose of life and what I want to get out of it. San Diego represented this new phase in my life where I no longer felt confident in who I was as a person anymore. I survived because of the beautiful weather, my amazing USUHS classmates, and my mom.

On days I question why I wanted to become a doctor, I try to remember what brought me to this moment. When I feel like a failure, or feel exhausted, or wish I did something else with my life, I try to think about the superficial struggles in life that tear us apart. The little things keep us going, but the little things are also enough to break us down.

I define myself by my academics, life choices, dedication, compassion, need to learn, and by my desire to change the world. I want to be a writer, but I don’t know how to write anymore. I want to be a doctor, but I am only beginning to understand what that entails. I want to stand out, yet I find myself hiding as if I am ashamed of being caught, of people thinking that I do not belong in this field because I question it. Is it bad to not love anything enough to want to do it for more than 12 hours a day every day? Is it bad to say that by throwing myself into one facet of my being, I feel like I am losing the rest of who I am? I try to take a deep breath at the end of each day – both the good and the bad – to reflect and remind myself that I am in a microcosm of medicine that is but a small piece of my career and future. I may not be the philosopher or writer I once hoped I would become, but I cannot lose the humanities side of myself and part of me that is so deeply engrained to love my patient more than I love medicine.

I might not enjoy new uncomfortable situations, but I constantly find myself doing things I never planned to. I sometimes think I crave challenges just to prove to myself that I am capable. That probably factored into my choice of commissioning into the Air Force (one of the best life decisions I have ever made). The military forces me to experience the world in ways I never would have otherwise.

Anyway, the existential life crisis continues. Throughout medical school, I assumed I would pursue psychiatry, but I am definitely considering pediatrics. I beyond LOVED my pediatrics rotation at Walter Reed, and it reinstated my faith in medicine. For the first time throughout my rotations, the faculty and patients made me feel like I belonged in medicine, which is a beautiful thing. I had never picked a baby up before nor changed diapers, and now I am pretty much pro at both (nursery week was my favorite). It is funny to think back at the cardiothoracic surgeon attending who kept calling me a pediatrician, because he said I was “too nice to be a surgeon.” Pediatricians definitely won the prize for most friendly field thus far.

So that brings me to now – I am currently in Omaha, Nebraska during this transition to being a third year medical student. Family medicine has been treating me well, and I love being with the Air Force. As opposed to the San Diego experience where I questioned if I should be in medicine at all, Omaha is giving me time to figure out how and where I fit in because the options are endless.

Pretty sure existential crises are healthy parts of introspective awareness. I have been doing way too much thinking this past year and could not figure out how to get it into words, so I appreciate anyone who took the time to read my stream of consciousness written on a late Sunday night.