Getting Ready for Third Year

In the week between the first session of the Catholic Spiritual Mentorship Program and orientation for third year (next Monday-Friday), I am relaxing at my apartment before I move to a new city to begin the second half of medical school. I am slowly packing

Both of my roommates have moved out, so I am alone. I also have very little furniture left, since they owned the couches, the dining room set, the easy chairs, the TV, and two thirds of the end tables. We also don't have internet, but I'm not very impoverished since I have a smartphone and plenty of places with free wifi (like the Newman center). It feels like 2011.

I have to learn to use the electronic health record at the new hospital system I'm working at, and filling out registration forms for badges and vehicle permits, etc. I feel like this has happened before, too. And my stuff is all half-packed again and I'm having time to cook and craft again, too. (I made a holy water font by pressing a statue into some salt dough, allowing the newly-made mold to dry, and then pressing more salt dough into the mold.)

More USMLE Step 1 from a Catholic perspective

Isn’t this video terrible? Our coordinator emailed it out as motivation, but it was so de-motivational (and low-budget) that I stopped watching before the half-way mark.

Don’t click on it and give it any views. Views are like currency on YouTube and I don’t want to encourage this kind of nonsense. I don’t even know why I bother linking it. (Research instinct?)

The fact is, no career is worth Step 1. Step 1 is terrible. The day of the exam, my stress manifested in vagal symptoms (even if med school puts me through awful test, at least it made me able to describe my test anxiety prettily) and I had no appetite. Eating was completely undesirable. I packed relatively tasty and fun food, but I felt like eating none of it. I was demoralized, especially after the first block; I was completely exhausted, especially by the end.

But it would have been incalculably worse if not for the true Faith.

Earlier that week, I’d emailed several groups of women religious and asked them to pray for me. I’d started a novena to St. Joseph of Cupertino: I purposefully chose an almost disproportionately short one, knowing my pharisaical temptation and tendency to be superstitious about my prayers determining the future.

Earlier in the morning, before I went to the test center, I went to daily Mass (as I had been during the end-game week) at the parish where I grew up. I asked the priest to bless me afterwards, and I knelt down to receive his (very Irish) blessing. He later told me he’d been praying for me.

And all through that day, I repeatedly entrusted myself to Jesus. “Jesus, whatever You want,” “Jesus, I trust in You,” “Jesus, You’re in charge,” “Jesus, do whatever You want by whatever score I get,” “Jesus, I’ll do my best, but the rest is all in your hands.”

And because of these things, at the end of the day and even during the test, I was at peace even though I was extremely stressed and felt terrible. “That’s pretty special ‘peace’,” you might object, “that admits of such awful emotions.” I answer that it really is a special peace precisely because it coexists with those emotions: it withstands them.

I contrast my Step 1 experience with my MCAT experience. My faith was much weaker three years ago, and the test was something I was doing for Jesus. I was demoralized by the questions and disappointed by my score. I couldn’t believe I’d done so badly, I felt terrible. My peace was gone, washed away by emotions. That was a peace that wasn’t founded on trust in Our Lord. It’s fundamentally weak. In contrast, the peace I am growing in now can coexist with terrible emotions because its source is outside me.

[picture of houses on sand/rock parable]

Back to the de-motivational video: no career is worth all those awful experiences. The price is too high; no mortal satisfaction (e.g.  prestige, money, fulfilling feelings in medical practice) is worth it. It’s like an endothermic reaction: the activation energy is too high and the products are too cheap. Why become a doctor when you can be a PA, NP, nurse, occupational/physical therapist, EMT, MA, psychologist, midwife, volunteer, or nurse’s aid and get the same fulfilling feelings? Why become a doctor when you can be a lawyer, engineer, investor, innovator, or manager and get the same money and prestige?

In "Doctors' Diaries," PBS followed a group of medical students to midlife and Dr. Jay Bonnar, who became a psychiatrist and was asked at the end of everything: 

Q: You could have become a therapist without becoming an M.D. It might have been a lot less expensive and anxiety-provoking. If you had the chance to do it over, would you go to med school again? 

Jay: You asked the question I said I wished I wouldn't be asked. I don't know whether I would do it again, but I can't do it again, so it's really kind of irrelevant. It is as it is. One can't live one's life over. I am here now, and it's a better place than where I have been, and I'm glad I don't have to do it again.

That quote always made me sad because I worried that he was right, and being a doctor wasn't worth med school. Now I realize, he's probably right. Being a doctor isn't worth all that suffering.

What is worth all that suffering is holiness, or doing the will of God. Medicine is my vocation—the fulfillment of my soul and the way God made me to love and save myself and others. And that is worth anything, as all the saints attest.

Stuff That Happened Before Step 1

So, I hinted in the last post that some crazy things happened to me during my Step 1 prep. Not only did I have to plan for an abbreviated prep time (most students at my school take Step 1 in the first week of June, but because I was going to be in Kansas helping at the first session of the Catholic Spiritual Mentorship Program, I had to to take it early), cancel days for three siblings’ graduations, and block out time for daily Mass and prayer (what, three hours of free time not counting meals and exercise??), but unexpected bizarre things happened in a time traditionally kept sacrosanct for study prep.

Thing 1: Scheduling Snafus

I scheduled my test (in January) on May 25 so that I could make the mentorship program. In April, I reassessed whether I should do this, and the test prep lady advised me to hold off on decision-making and extend the test date to June 11 (after the program). When I realized that I did indeed want to take Step 1 before the program (I am so so so so so glad I did, I would have certainly done very poorly if I hadn’t), I rescheduled and went online to get my May 25th date back.

I realized that the appointment I wanted (8am to 5pm on May 25 in my hometown) was gone. There was a 10am to 6:30pm on May 25, but I really didn’t want that, since I’m a morning person and didn’t want to waste two or three of my best hours. I hesitated to take the slot, and during my two minutes of hesitation the spot was taken by someone else who was also online and looking at slots. That was the last May 25th slot in the state. I ended up with a May 24th slot for 10am to 6:30pm. (Happily, I got to Prometric that day at 8:45, being a morning person, and they let me start early, so at least I was still awake at the end of the test.)

Thing 2: Carpal Tunnel

It's possible.

My study strategy is to rewrite what I’m reading and reorganize it, which is a form of the teach-back method. However, rewriting a 600-page review book in my small (like, 8-point) handwriting on marginless computer paper, combined with taking practice questions on a computer that applies pressure to your right volar wrist can give you carpal tunnel syndrome. Believe it or not, I actually induced my own carpal tunnel syndrome by overuse of my wrist studying. I remember thinking at least twice, “huh, my wrist sort of hurts. Hope I don’t give myself carpal tunnel syndrome. That’s probably not even possible.”

I didn’t believe it was carpal tunnel at first, and thought, “it’s just some kind of cramp or overuse fatiguey thing,” until I actually had paresthesias on the palmar surfaces of my second and third digits…then I realized I’d truly lesioned my own median nerve. Sad face! Sadly, this happened right before microbiology (lots of details) and biochemistry (lots of details + not my best subject). But happily, I was able to transition to speaking the material aloud (another form of teach-back), which hopefully worked just as well. I rested my wrist for a few days, and then went back to using it. It still doesn’t like me much, especially since during the program I’m in charge of several laptop duties, including real-time typing of audience responses on a projected screen.

Thing 3: End Game Unexpectedness

So, the last week before Step 1 is taken (called the “end-game” by our dean of students) is a very important time for solidfying an excellent score. In the last five days, material can slip out or things can be can be pressed in, and shaken down. In the last five days, the short term memory can be maximally filled with the silly details like gram stains. And in the last five days, a person can lose confidence and freak out.

It’s very important not to take a practice test within that last week. I did (oops) because that’s what my schedule told me to do, and technically I took them on a Saturday of the week before my Thursday test. I actually took two (NBME 13 and NBME 15) on that Saturday, totalling 400 questions in eight hours.

It’s very important to not make any changes to the study routine within that last week. I did (oops) because I moved home by accident: I had planned to drive to my parents’ house to meet them and drive to my brother’s graduation. But at the last minute their pet-sitter canceled and I found myself house-, dog-, and younger-sister-sitting. Without my desk, I studied at the kitchen table without much issue, except for the one-year-old not-yet-fixed male Golden wanting to be petted, played with, or walked.

It’s very important to have a quiet place to study throughout Step 1 prep, but especially within that last week. I didn’t (oops) because I moved home and didn’t know where quiet places could be found. I didn’t belong to a university in that city, so I had no parking at the colleges with actually quiet libraries. I tried my high school library, which welcomed me warmly but was a little chatty (all girls’ Catholic schools are chatty, big surprise) and then I was interrupted by a tornado-warning-induced early dismissal from school. I tried the public library, which was an even bigger mistake, since it’s a central hub for anyone who needs the (incredibly slow) internet and since it becomes about as quiet as a playground when the three or more surrounding elementary schools get out.

It’s very important to keep whatever you’ve been doing to exerce in that last week. I didn’t (oops) because I packed for a graduation and a few extended family dinners. Modest running shorts are not traditionally worn to either graduations or family dinners. Sans shorts, I was sans running (except for walking the energizer bunny—I mean, the dog).