Reih7’s Weblog

Easy day today. I got out at 9:00 (am!), and hit the gym, then read for a few hours. Went to get blood drawn, went to lecture. I sat there in a daze, sort of hungry and light headed, wondering if this is what I wanted to do with my life.

Was freaking out too much about the whole situation so took myself shopping and bought new gym shorts and some groceries. Also got a fucked up iPod car thing that I spent $14 on just so I could hear a staticy version of Death Cab blast through the worn speakers of my ghetto mobile. Honestly, there’s a certain joy that comes from driving around on 50-degree days, windows down and heat blasting while you play your favorite music. It must be a midwest thing.

Came home, ate, ate some more, wondered what the hell was wrong with me. Tried to research away rotations then realized that all the dates were off at the programs I wanted to go to and that I better get SOME applications in or I really would be a total failure. I worry (a lot) that this whole residency application thing is gonna pass me by and I’m gonna be like “Psht, whatever” and just…like…forget to apply! The whole not-wanting-to-get-out-of-bed thing this morning isn’t like me…neither is academic apathy. I can’t handle this.

Changed into PJs and thought I’d check my blood labs before I went to sleep. Mistake of the world. Saw my liver enzymes are bumped and the word ‘hepatitis’ popped into my head. Called Poopy.

“Hey, what’s up”, I said when he picked up, my voice tired after resting all day.

“What’s wrong??” It’s the first thing he says, picking up on the subtle change in my voice.

“Ha…no-thing..”

“Oh my god, seriously, what’s wrong”

I laugh. “I know, I’m a shitty liar today” I finish pouring water into the coffee pot and walk back to the computer. I explained how I got labs done and how my liver enzymes are up and how I’m worried about heptatitis now and beyond all that, I tell him about my striking apathy about everything. For him this isn’t news…he INVENTED apathy. This boy sleeps till 2:00 and calls it early. It drove me crazy when we were together, and now I get back at him with 7:00 am wake up calls to tell him the birds are chirping and it’s a fucking beautiful day outside. Really, for me to not want to do this is…new. Beyond just unusual. It feels like someone has poured tar into my brain and I can’t seem to think about the future. I can’t even make a fucking decision about what specialty I want to go into! Jesus I’m a mess.

Anyways.

I tell him all this and he listens and asks questions trying to sort it out. He asks, “Do you think if your health was better you’d be able to concentrate on this residency stuff?”. I pause. Yes. Yes I definately do. It isn’t as if these doctor’s appointments are taking up that much time or anything, but it makes me FEEL sick. It makes me feel weak. And I honestly start to question whether or not I want to go into a specialty where you have to work your ass of. Can I even handle it? Or should I do something easier? “Psht, you should do something easier regardless of your health,” he says, “Why would you do something with more work!”.

This from Mr. I’m-a-partner-at-a-hedge-fund-and-sleep-2-hours-a-night. He’s just trying to be funny, to make me feel better, but I’m not in the mood. He says: You’re just finishing this thing off! This is the end of all the stuff that happend to you!…but it’s not. My bones are thin already and I’ll have vertebral fractures by the time I’m 40. This fucked up knee will STAY fucked up, and now…now who knows what badness has happened to my liver and other parts of my body. 

“Well, there’s nothing you can do now!” He’s getting on my nerves now. I don’t yell. Yes I could do something. I could go on bisphosphonates, which is what I’m going to the doctor to discuss tomorrow. The drawback is that I can’t have kids. Or rather, I can, but they’ll be all fucked up so I’d prefer not to for both of our sakes.

“Oooh…so you can’t have kids. Well, there you go.” His tone has a light finality that only someone with a penis could have. “I mean, can’t you just freeze one of your eggs or something before you take that medicine?”

Yeah. Yeah I could just freeze one of my eggs. I’m too tired to get all riled up. For maybe the third time in the 10 years we’ve known each other I brush it off. “Yeah. Anyways. I’m gonna go to sleep”, I whisper, and listen to the silence on the other end for a full 5 seconds before hanging up the phone. I know my lack of fight makes more of a statement than anything I could have said at full volume.

This. Sucks.

5:00 am - Phone alarm goes off. I roll over, look at the phone, and stuff the blankets in my ears.  

5:05 am - Alarm clock #2. Reflexes take over and I shut it off before the third beep. I flip onto my back and stare at the ceiling. There is nothing I want more in the world than to stay horizontal.

5:07 am - Phone alarm goes off again. Oh fuck it. Stumble to bathroom to grab toothbrush and wander blindly around kitchen making coffee while brushing my teeth. Slap together a PBJ, grab some snacks and toss them into a bag along with gym clothes and some gum.

5:15 am - What it would be like if I just didn’t show up. A renegade med student…would they kick me out? Would I get another chance? Fantasies of playing hooky cloud my vision. I could be at the airport in 20 minutes, I think, as I shove my body into clothes that don’t fit right. The familiar self-critique starts and grows until it fills my head: You eat too much, you’re too big, your clothes are too tight, what the hell are other people going to think when they see you, etc. There’s a pressure behind my eyes and I pop a prophy Aleve.  I strip off the dress shirt that overnight has become too small, exchanging it for a large sweater.

5:20 am - Put my hair up and throw in contact lenses. I lean in close until my face fills the mirror: Eyes are red and puffy, hair is nappy but passable, skin is clear as usual. Grab some eyeliner and run it under my eyes, in keeping with my promise to myself that I’ll try to make an effort with this body. Stepping back I do a once-over of my head and switch off the light before my eyes have a chance to skip below my neck.  

5:25 am - Find white coat and start filling it with various medical-looking stuff. I take a swig of coffee and savor the warm, bitter liquid as it passes over my tongue, through my esophagus and into my stomach. Before the next sip I gather my collection of daily pills: Vitamin D pill and a probiotic (which look like gems); calcium and a Flinstones pill (which look like stones). A gulp and a swallow and they go into my gut where they’re supposed to heal my stress fractures, regulate my intestines and make me whole again. Oddly enough this makes me feel better. Healthier. Like I’m finally doing something good for myself.  

5:30 am - Ooh yeaaaaah…Coffee is beautiful! LIFE is beautiful! I start to think maybe this ORTHO month will be beautiful! Goddamn I love caffeine.

5:40 am - Grab my bags and head towards the door. Pause to light incence in front of ghandapati statue: “Please don’t let me fuck up. Please keep me sane.” Translation: Please help me not become an out of control fat pig. Give me the strength to not eat like crazy. Oh yeah, and here’s to hoping that Day 1 of 4th year goes well.

…Here we go for Round 2.

When I started medical school I was 73 pounds and damn proud of it. Starvation takes over your mind. The body has some built in mechanism where once you pass your lowest weight threshold you’ll try to do everything you can to survive there. I try not to bore myself with the details of my journey thorough thin and thick and really, I don’t think I can remember the details. It turns out that your brain also disappears with the rest of your body, so I can’t remember a lot from the past few years. I do remember some things: Running myself to exhaustion in -15 degree weather. Ending up in the ER a week before college graduation, getting pumped full of fluids while two of my best friends sat with me in the dark. Curling up with my grandmother in the couch-converted-into-a-bed where she spent her days until she died, our body frames comfortably fitting between the cushions with room to spare. We were disappearing together, and then it was just me.

It stayed that way through the first two years of med school. I tried to go out, make friends, see people…but it’s hard when people realize that you don’t want to eat. Through some fluke the girls that I’d gotten to know in class also happened to be “foodies” and I was scared to death. They sat around and talked about recipes and restaurants and ‘healthy eating’ and it all made me want to vomit so I tried not to see them much. I studied instead, a huge change from my previous life in undergrad. No more random 3AM drop-ins to see friends, skipping class, thursday night happy hours, etc. Nope, I took medical school seriously because I’d started taking EVERYTHING seriously. I thought my body was perfect, and everything else should be perfect too: my grades, my new condo, my life. I started reading home décor magazines and making scrapbooks. I tried to make my mom happy (an impossible task). I ate salads and obsessed over my hair and got upset if someone interrupted my routine.  Everything was transient, nothing really mattered beyond school and whether or not I’d met my calorie goal. Maybe the body has a way of protecting the mind from starvation, because I felt euphoric every day. I would sometimes go see my ‘eating disorder doctor’ between classes and he’d tell me my heart was dying and I’d tell him I knew and then I’d leave, thankful that I hadn’t broken 80 on the scale. Every now and then I would freak out, eat too much and have to get ‘back on track.’ Sometimes I would run away to see a good friend in Chicago and take comfort in her stability while she sat with me and fed me pancakes. All in all it was a shit way to live, but I didn’t really know it or care.

Anorexia isn’t like breast cancer or a car accident. No one says “You poor sick thing, let me stay by you in your time of need!”. Instead everyone looks at you like its your fault and then leaves. The last year of college my friends banded together and elected one of my closest friends to talk to me. “They just can’t handle you,” she told me one night, “They want me to say something to you but I don’t know what to say.” I stared at her. This is the girl who I’d stayed up with while she freaked out about getting into medical school, she was the one I stood up for when she tore herself apart for being “stupid”, she was the one I was sure I’d know till we were old and grey. To her credit she tried to keep in touch but she had her own life to lead while I tried to destroy myself so it was a very unbalenced relationship. Either way, the rest of my friends pursed their lips and moved on, telling each other “well, she just has to help herself before any one of us can help her.”  My own theory is that anorexia makes people uncomfortable because, somewhere deep down, they’re morbidly in awe at the level of self-control it takes to achieve such low body weights. I wasn’t scaring anyone with my mortality; I was scaring them with my determination. I wouldn’t go as far as calling it ‘jealousy’, but something akin to that. I could feel my friends retreating, watching me like they were watching a glass doll make her way through a windstorm (i.e with squinted eyes and clenched teeth). And I didn’t even notice because anorexia is a very self-absorbing diseases, but now I realize that after three years of medical school there isn’t a single person in this town that I could call up to get sushi or see a movie. I intimidated them with my bony frame, reminding them of their hidden desire to be a medical nightmare.

It’s a curse being big and fat again because I feel like I’ve been in a coma and have just now come out of it. It’s like the past almost-four years didn’t happen and I’m suddenly the same girl I was at 21, all bubbly and excited and ready to take on medical school and the rest of the world. But everyone’s gone and married or in some other career and I’m wondering where the hell I was the past few years. I spend hours on FaceBook trying to piece together people’s lives that they’ve been living while I was busy dying; trying to remember what it feels like. I have to teach myself how to be a person again and somehow find a way to re-enter normalacy. Before all of this I was hilarious, brazen, strong. I stunned people with my self-confidence. All of this sitting alone stuff is…new to me. I don’t like it.

But I’m not alone. I have a wonderful bestest-friend-in-the-whole-wide-world who is like my other half. He never left, probably because he one day wants to marry me and father my children (and after all that! I can’t beleive it either). There are a few friends in Chicago who I can always call and go to when I feel like cutting myself open and some scattered friends througout the rest of the country. The people I still talk to are the ones that stayed, the ones who treated me like the person I used to be even though I was nowhere near it. They’re the ones that came to see my in the hospital and cried when I reached my goal weight. It’s a handful, but they’re out there.

Somehow I’ve managed to find people in school here that I talk to and get along with and, recently, go drinking with. It’s like grass after a snow: it keeps growing. No one “knows” about the anorexia but it’s not like they can’t guess. A 30 pound weight gain is hard to miss. I don’t doubt that things will get better because, unbeleivably, I’m not bitter or jaded or cynical. Yeah, I was really sick, did things I’m horribly ashamed of, watched my friends give up on me and somehow I’ve come back. I don’t blame anyone, not even myself for the past few years. And now? I’m returning after my time away and looking around with wonder and awe. Little things…colored leaves, a good song on the radio, weekend trips to Chicago…. I could have missed it. I could have chosen to lose faith in people and withdraw and decide to just fuck everything and everyone. I could have left it all, but instead I’ve started taking up space again.

Ooooh I got a long way to go and will probably spend the next year getting myself together. I have massive stress fractures in my legs, I haven’t had a period for almost 4 years, I have no concept of when to eat and when not to, I hate my body, and the list goes on. But today a classmate emailed me to see a movie, and I had dinner with my dad for probably the fifth time since this all started and I wasn’t scared. I have to beleive it’s coming together. I’m picking up my armor, cracked and warped from years of abuse and dusting it off. I’m putting the pieces together and shining all the parts so that this time, after I straighten out all the kinks, I will blind people in the right angles of sun light. I will be fucking bulletproof and move on and over and OUT of this forever.

“She’s going to make a great physician!”

It’s a sentiment that I’ve heard from more than one patient, usually said when the attending and I are in the room after discussing the patient’s case and deciding on our recommendations. The first time I heard this said I didn’t quite know how to react. A small part of me was proud, thinking that my behind-the-scenes work of ear peeping and note writing had finally paid off, and in front of the attending no less! Another part, the larger part, was embarrassed. I could just imagine what the attending was thinking: “A great physician? Because she takes a mean blood pressure? Yeah right!”

The truth is, I’m not that smart. My shelf scores hover around or slightly above the average in my class. I did do well on my boards, but I’m sure it took significantly more time and energy on my part than my colleagues. I worry every day that I’m not going to get into the residency program of my choice because of “numbers”. On the wards I’m only slightly better. I’ve been told my presentations are alternatively “scattered” and “too organized and detailed.” I keep trying to gather my thoughts into a concise formulation of assessment and plan but usually end up falling short. It’s not that I don’t know the pathology or that I don’t care; it’s that I don’t know how to spit it out so it sounds like I’ve been doing this my whole life and takes yet only a second. It’s a different experience for me; someone who has done well in academics her entire life. It feels unbalanced and unfamiliar to not be at the head of the class.

I do have some unexpected strengths, none of which are conventionally measured. My last attending told me that I have the “unique ability to identify a patient’s barriers to care and help confront them.” I have an extraordinary ‘third-sense’ about things or, as it’s more commonly called, clinical judgment. And, most surprisingly, I’ve become good at comforting people. I’m not a comforting person. I’m not very emotional and I really don’t know what to do with people who are. But throughout this year I’ve learned to say phrases such as “I understand that this is difficult for you” and “We are all here to provide care and support “ without sounding like I’m faking it. And I’m not (faking it, that is). I really do mean it because despite my hard exterior, I care so much about what happens to these people. My attempts to identify my patients barriers aren’t to get them out of the office. Rather, it’s to help them feel well as fast as they can so they can get back to living this glorious life.   

The patients that tell me I’m going to make a “great physician” aren’t the ones I’ve spent the most time with, but they are the ones who I’ve listened to. We all know the type: People with multiple medical problems who have been through the system, seeking care and something else. These people want and deserve a “cure” to whatever ails them, but they also are looking for comfort, reassurance and someone to listen to them. Whether or not that job falls on the physician is a question that’s been debated. In today’s world of 15-minute office visits and mountains of paper work a physician is hard pressed to find the time to be the support system for their patient. It’s easier to punt to social work or support groups or non-existent friends and family members. But the truth is, it doesn’t take much longer than 5 minutes to ask “Tell me what’s bothering you” and then offer some phrases of comfort. People argue that a physician’s our job is to cure the body, not heal the soul, but these patient encounters tell me otherwise. They don’t care that my attending and I have no new ideas or medicines to offer them and that we still have no idea what’s going on. They say I’ll be a great physician because I listened, cared, and tried to help them help themselves.

I’ve always favored reading over socializing, math over social studies, analysis over memorization. I can spend hours taking apart a problem and putting it back together or researching a diagnosis and trying to find a solution. I’ve never been good at talking to people about their problems and never really wanted to be. Nowadays, I find myself in the opposite situation. I am learning medicine, but I’m not excelling at it the way I have in my past studies. However, somehow during the course of this year I’ve mastered is what’s been called the “humanistic” side of medicine, the part that was always lacking for me in the past\. I have a long time to iron out the kinks in my presentations and fill the holes (thankfully not gaping) in my knowledge. But what I’ve learned about connecting with patients couldn’t be taught to me through books and numbers and it’s something that will stay with me throughout my career to becoming a “great physician”.