2

Tomorrow is my last day in study jail.

I have some small goals.

3 blocks + review in sequence.
FA review
Smart sheet single pass
Goljan
Drugs and possible firecracker until 8.
At 8 full Yoga/Workout until I can't move and sleep.

Today was an excellent day.

breaking point

I'm grateful for understanding, the air, and the inevitable passage of time.

This is a process. For the past few days I fell out of the routine. I ignored the calendar and did other things. At this point in the game the focus is everything - cultivating a routine and a sound mind which is capable of recalling.

Today I took NBME 17 and scored 20 points lower than the UWSA 2. That being said, this test tends to underpredict.

My score was low in pharmacology, behavioral, ethics, and I was tripped up on physiology and biostats.

To resolve this, I re-read some pharmacology sections and revisited my sheets. They have many details which I fought hard over today.

Ultimatums and mandates don't work. Being goal-obsessed is not healthy. The drive of becoming better comes in the fact that we can gently remind ourselves to keep coming back to the moment.

I'm not going to fail this test. I'm well within matching-range of psychiatry and at the number of EM - and I consider this one of the worse testing days.

Things I am changing - Temperature control. RNP - I made 5 reading mistakes because I was rushed or not comfortable. Coffee: I should have at least 1 cup to wake up. Eating - dense protein. Stamina: I need to start doing serial 7 tests. Sleep - I am going to try to exercise much more so I can sleep before the test.

Things I did well: Meditating before the 1st block...I only missed 3 points. As time passed the score dropped.

Tomorrow I will do questions in the morning, catch up reviewing the rest of Kaplan, review my UWorld stray blocks, hit firecracker hard, hit micro/pharm in the evening, and do my smart sheets at night. Kabat-Zinn death meditation and yoga flow for breaks.

No facebook, no articles, no drama for the rest of the time. Today was a wakeup -- I was sleepily believing that I would get a 252 on this test and today made me realize what's really at stake.

It's not about the score, though. It's about discipline. This is who I am - I don't quit when it's tough - I grow.

17 and concerns

I am grateful for my capacity to understand, to adapt, and to make a situation change for the better.

Today was a fractured day. I'm concerned about the future and a special person. We talk every day but since we spoke Wednesday we have had very few words between us. I know that Thursday she was going to the doctor and she said everything is fine.

When I started studying I said we'd suppress everything until after the test. That seems like a really bad idea because I'm worried that something has happened to her and she's not going to say because she thinks it will worry me.

At this point in the course of our relationship I realize that being together takes trust and communication. I promised her before we left Grenada that I wouldn't sleep with anyone else and I would visit her in Puerto Rico. She didn't trust me then, telling me later that she thought it was the last time we would see each other. She didn't trust me when I changed an online dating/social media status to my new city, and changed my "looking for" from "relationship" to "friends". She didn't trust me in Turkey and demanded that I say what I was doing several times.

Things have just built to the point that, with the momentum and pressure of the moment, I would rather just set things straight. The words "freedom" and "less stress" were thrown out as reasons for having a more open relationship.

I'm sticking to what I said - I don't have the desire to pursue romance in Ohio; I think I might need to explore the consequences of this trip. I bought my ticket to Puerto Rico. I want to go and share that experience with her. The context is less important to me than the fact that I actually really want to go. We could be friends, lovers, official parejas. Those 10 days I have been looking forward to since she told me about her island - if she happens to have a serious problem that prevents or impairs my trip...it's better to know now so I can deal with it.

today:
4 Kaplan blocks done and reviewed
10 USMLE questions
4 pages smart sheet
60 flash cards
FA pulmonology section finished
15 anki FA cards

Tomorrow I will:
do 4 med/hard kaplan blocks
150 flash cards
15 pages smart sheet
1/2 repro section
speak with Rocio

I realize that I'm

18

I am grateful for memory, moments with family, and popcorn. 

Today was a disrupted day:

241 cards

2 Kaplan blocks + review

1 USMLE block

30 anki path cards

12 pages of smart sheet

The internet was spotty and I kept jumping mentally around. 

I got a leg workout with cardio.

I spent a quality moment with my niece and taught her how to put away food. It's fun now that we can interact. 

My goals are going to contract even more. Focus is the main priority. When I hit Tuesday I want to be finished with Kaplan and reviewing its sheets. 

Tomorrow: 

4 Kaplan blocks + review - straight for endurance.

FA - Respiratory

15 smart sheet pages

200 cards

My USMLE block went OK. I thought I did worse than what happened. Next Saturday I take another NBME and at that point I'm finished with new material. Timing and tuning will take over - UWorld blocks, smart sheets, firecracker, and FA dusting if I miss a question. 

If I took this test tomorrow hungry and tired I would score a 220. All I need is a 220. I bet I get a 236 to tie Falcon. The journey is continuing. 

19

I am grateful for all the food I've been able to eat and that my body has been able to keep itself intact these 26 beautiful years.

Today was a slow one - but good.
4 separate kaplan blocks done and reviewed 80, 82, 84, 86
My average has gone up to a 78.
I did over 100 firecracker - there were some surprise extra problems that were tough.
Read the psychiatry section of FA
Reviewed 10 smart sheets
some path slides

personal life:
got dinner and caught up with an old friend
talked with Patty

My goals might have been too high.

Tomorrow I'm going to focus on the USMLE blocks - I was curious today when I saw them.

Tomorrow I will:
USMLE 3 blocks straight
Kaplan 2 blocks + review
Firecracker 280
Smart sheet 10
Renal FA - 10 pages
meditate/yoga/PIES
Workout legs/cardio

20

I am grateful for hope - yet even happier for an enjoyable process. It's tough - but every day things get a little clearer.

Today I didn't quite meet my goals.

258 flash cards
2 Kaplan blocks done and reviewed
2 audio
1 Rx block done and reviewed
finished the FA neuro section
10 pages smart sheet

personally:
I drifted onto facebook. my new rule is none in the study room.
I worked out for an hour of cardio and hit back/bi hard.
For lunch I ate with mom for a half hour - open faced toast with fresh tomato sauce.

Tomorrow I will:
smart sheet 15 pages
5-6 Kaplan blocks
186 firecracker
Cardio, legs, possibly deadlift
20 pages FA psych

I know I can do most of that.

21

I am grateful for the track and progress, resolution, and becoming.

Today:
1 Goljan audio
3 Kaplan blocks (77, 87, 82). Reviewed
Reviewed 1 UWorld block
137 Firecracker cards
5 smart sheet pages
FA Neuro 25 pages

Personally:
Workout chest and tri +20 min cardio
Spoke with Rocio for 30 minutes
Yoga - 7 minutes
Read Peace is Every Step
Health forms completed and accepted
Printed smart sheets
Setup FB event for post-step gathering.

Tomorrow I will:
Do and review 3 Kaplan blocks
Do and review 1 Rx block
Review final UWSA 2 block
Firecracker 250
FA Neuro 15
Smart sheet 10
1 Goljan audio
Workout back/biceps
10 minute mindfulness or yoga
peace

Every day is beautiful. I have found my stride and peace in the fact that I will pass this test. The score is arbitrary to me - the process has been beautiful. I anticipate getting between 230 and 250. A number lower than 236 means I will just try differently. A number over 250 means this process was worth it.

smooth bumps

Last night was excellent and then kind of terrible. Being a medical student means that you and your SO will scrutinize and look up every single problem (or perceived problem) and assume the outlandish.

After an intimate night with R I woke up at 6 - refreshed and driven. This morning I meandered through some difficult concepts, revised my herbal medicine notes, and did some questions on brainstem lesions. I am so grateful that I can localize most strokes with basic symptoms.

One week from today I will have finished my basic science training. I was thinking that today when I kissed R on the forehead as we watched the sunset together. She has delightfully forced me out of the ruts of studying that I sometimes fall into. I was drilling the same 10 drugs over and over going nowhere when she said she was upset - I told her to jog out to the cliff and meet me. It was delightful.

Then I met up with my friend B for dinner. We revisited the memories of first term and chatted about the group dynamics and how we grew to interact with each other. Now I'm ready to settle in for an early night.

Tomorrow I will attend my last small group, take my last BSFCR quiz, and do my last clinical correlate session in Patrick Adams hall.

It was ironic to have an awards ceremony so bare there last night. White Coat was to the brim with medical students eager to embark on the journey. About 50 were in the hall (we started at 800) and the other 550 in my remaining class left to study for "the most important test of our lives".

Those words don't really mean anything - all tests have been that important.

If I failed at any moment during my training I would have left. July 14th doesn't come with any real mystery. The real test is finding joy in every day and maintaining excellence in mind, body, and spirit. I am driven, healthy, and unbroken.

Bring on the pharm!

May Day

It's sunny outside. The birds are singing and the woman is sleeping in after an entertaining movie kept us up a bit later than usual. It was a luxury - and the sensationalism of the experience was incredible.

There have been many incredible moments in the past two weeks. Free group salsa lessons on campus, re-learning the brainstem, finishing the OSCE, watching flowers with a beautiful and fun person, and long/deep meditations.

I got the money back from that excellent trip in Turkey and briefly presented what the discussions were about.

My date is set and I feel focused, driven toward the goal. Things get rocky here and there.

Recently I had trouble viewing my health records but now they're available. I need to visit the doctor to get a TB test, history and physical.

I lost weight (and found some of it again). Crossfit is a fun cardio workout and it makes it easy to burn some calories and make some friends.

Two days ago I had a great day with R - we played catch with a medicine ball and exercised on the machines. I was having a low-focus day and it picked me up to just talk to her and try to alleviate whatever anxiety she was having about Sunday.

It's so lovely to have someone who speaks Spanish to practice with. Moreover, she's an upbeat person who keeps me in check when my pessimism or bizarre thinking interferes with me being happy. At the same time, I'm better adapted to handling large amounts of conflict, so I can support her when she is feeling overwhelmed.

It is May - which means that it's mindfulness month. I would like to journal every single day to build a good habit. I've heard that 60 days is the minimum time required to form a habit - so now is a great time to start.

A good morning kiss after brushing my teeth and washing my face is an excellent, mindful first activity. I think I will go do that now.

a work week after weekend of play

The blessings are almost too many to count! This past weekend I spent most of my time with the lady friend. She wrote me the nicest card for valentine's day and got me a box of her favorite chocolate.
We enjoyed most of Saturday night and Sunday morning together and then went to crossfit.

Last week was a smooth and easy week. The BSFCR quiz was do-able - I got a 90 most likely.

I've been keeping up with a lot of questions and have lost the extra weight I put on around unified.
Midterms and Turkey are getting closer. Recently I've been going to a lot more meetings with SCORA to make sure that things are going smoothly. Ghislaine is doing a wonderful job and I'm really hoping that the program continues to thrive.

3 nights in a row I was with mi chica. It's a really special feeling you get when someone looks at you and wants to hear about you, enjoys your touch, and laughs at all your jokes. The same pull goes the other way - you want to share the joy of their success, support them in their struggles, and listen to their wonder about things.

There should be some useful tools on my way: an exercise monitor, a smartphone, and a book on meditation.

I had the special privilege of going to a beachside yoga practice recently. Something about the group atmosphere makes me connected and happy.

The doorframe experiment has had a lapse, but today I will pick it back up. Everytime I walk through a door I will breathe deeply, smile, and stand up straight. I will take in what is on the other side and approach it with friendliness.

Midterms are next week. Staying strong :)

fire out the gate

Monday morning was  fantastic blend of confusion and excitement. I did a question block, watched some videos, shored up and submitted an assignment, made a delicious concoction of cabbage, eggs, garlic, and onions for lunch and had a balanced day.

Sunset yoga was phenomenal tonight! It only cost 5 EC and I felt so refreshed and tired after. There were locals and students. We did a lot of twists, leg stretches, and a split legged bend that I want to try between blocks.

I'm getting closer to a routine which I will do between question blocks.

Mi chica ran into me and we had breakfast with the clinical tutor who I think is named Gustac or something like that. It was a nice twist on forgetting my lunch.

I came home at noon and focused on lectures and drugs. My friends and I are planning to meet Wednesday either before or after salsa. It is getting easier to focus. On Rx it displays a score which we would get if we were taking the test right now. Mine is 202. That means I would pass - barely.
Right now I'm grateful for time, fellowship, and the chance to do it better.

Every day I do it slightly better. Scheduling is key. Discipline is paramount. Although I skipped the run today, I had an excellent crossfit workout.

Tomorrow I will try to sign up for the ITLS course, submit my final paperwork for the integrative medicine selective, email Dr. Baldwin and Dr. Ross. Round at the hospital with peidatrics, and kick butt in lectures. I don't have anything social planned - today felt lonely at times, but that turned around when I went to yoga.

The hospital should be enough contact.

Really, I'm grateful for this time to realize how much there is to know and I'm grateful that there will come a time where I will not go for a day without talking to someone (unless I decide to be a pathologist).

The weekend was full of joyful early morning and late night moments. Last night was a brief review of biochem and a romp with mi chica. She makes everything brighter. That's something I don't want to think about too much - and I'm glad that I have time for now.

Now it's time to sleep. This week is starting off strong.

Today I woke up at 5:15, felt my sore legs, rolled over and slept until 6:15. After waking up I left the coffee on without water, had some oatmeal, cooked an amazing lunch but forgot it. I spent many hours today listlessly learning random facts.

130 firecracker Q's
13 Rx Q's
2 videos
Sonic 3 lectures
Ankified 65% of antiarrhythmics
Finished my ICM assignment
Reviewed 17 cards

Today I did many other nonspecific  things
Had an excellent talk with Dr. Baldwin
Attended my honors meeting
Danced with the PR girl for 15 minutes
Had a good chest workout
Met a pediatric cardiologist who practices in Cinci
Talked to a few friends
Folded and put a way my laundry
Bought some groceries
Talked to Taryn about the ITLS selective
SHOR requested my UWorld subscription
Looked at residency satisfaction rates
Meditated for 15 minutes

It was a very light day but I'm ok with that. I feel like I didn't do much but then I look at what I did accomplish and it doesn't seem too bad. Tomorrow I will go to ICM in the morning, visit Dr. Gray, visit Dr. McCann, and ankify the rest of antiarrhythmics. In the evening I have to kick into gear with more study. Tomorrow morning a run might do me good.
I'm supremely grateful for sleep, exercise, friends, and music.

I wore a light white shirt and khaki shorts. People were impressed that it wasn't as scraggly as usual.

grattitude = grateful attitude .

Since Friday so many wonderful things have happened. My dad got over his strep infection and my brother made up with his wife after a big fight over her being pregnant again.

I'm polishing off the last glass of Talacasto wine. It's $3/bottle in Grenada and the bottle typically lasts me a full week. After a long day of studying it's a perfect way to slow down.

Friday night I met Sam, the boyfriend of a girl I used to have some interest in. He's a good guy and they are very much into each other - which makes me extremely happy. I took my current love interest out with those two and our friend. We went to a local brewery to spend an hour. We laughed a lot with the random enthusiastic first termers who were figuring out the island.

An intense labmate of mine came on strong to the girl I'm seeing (I'm just going to call her Rox for this blog) and awkward. It's always fun to see what people assume about someone before they know the person. People assume med hangs with med and we're all from the USA if we're light skinned.

I'm amazed at how I DON'T realize some things unless they're pointed out to me - but Asians talk about being Asian more than any other group of people I hang out with. Really, I don't think about being white until someone brings it up - then I'm uncomfortable or irritated. We're all just people...except Rox and the Puerto Ricans I've met ... Latinos are fantastic!

After the brewery we grabbed a drink from a local van and walked to the highway. Chris and Sam were running, piggyback ahead of us.

Rox and I settled in together for the evening - una fuente de emociones y placer. The next day I studied and went hashing - discovered razor grass and decompressed thoroughly. There was a mixup on the trail but, as always, I met great people there.

Yesterday I had a couple tripups and backslides - but in the end everything was ok.
Today I went to the simlab and reported for an "attending". We performed physical examinations on sim patients and acted out scenarios. It was extremely helpful and educational.

I'm grateful for my friends, my house in Grenada, my connection to Rox, and for the things to come. Life is good.

jog and journey

This morning I had a long pleasant jog on the beach. A rasta ran beside me. His name was david and we talked about our journey for about 10 minutes.

Today I went to the hospital for the first time as a medical student. I made a few mistakes - misstated the causes of finger clubbing and reported an odd BP reading...probably missed the auscultatory gap. I'm glad that I make these mistakes because next year the attendings may not be so kind as Dr. Rooney was with our group this morning.

The patient had a reasonably complicated case and was extremely friendly. It was exciting to get that interaction with someone for the first time - even if I was just taking vitals and asking about a few symptoms as a part of a team of 6 students.

The hospital isn't as bad as people said. Sure there are no TV's or AC...but they have beds and what appeared to be fresh linens. There were nebulizers and cups for medication. The essentials were there. The staff seemed competent.

After that I had a long talk with a former group member about studying for the USMLE. It is a daunting task - and we have 6 months to accomplish it - but I'm confident that I will score what I need to score.

Tonight I went to yoga out in Grand Anse. The session was physically demanding and it took me a while to get centered after the session. I know that the feeling of peace is lasting but not permanent - so I appreciated it as much as possible. In the future I will alternate between mindfulness training and yoga.

After yoga I came home and did sonic for 2 lectures. Then I finished up some firecracker and skimmed some notes. My mornings usually include 15-25 USMLE questions after jogging. I also clocked 20 QM and 3 vids. It's a marathon :)

Tomorrow will be excellent. I get to spend time with salsa and the woman from Puerto Rico after a moderately difficult day. ICM in the morning and a solid 5 hours of vids/firecracker/FA/class notes.

on the rock

Today was a hard-hitting day. I woke up at 4:40 - too early. Slept until 5:25 - just right.

It was dark on the beach, but the birds had begun their morning songs in Mont Toute. The sand was particularly flat today - which made it easier to jog. It was beautifully cool and I took a refreshing shower after the jog. 23 minutes and 15 seconds. I stopped for a few seconds for traffic - but it's a higher time than usual.

The morning went along nicely after. A focused half hour of questions, 17. Firecracker - 30. Videos, 2. Finished pharm lab. Ate an omlette and finished pharm anki. Firecracker and another video. Overall I did 106 firecracker. Pharmacology quiz was really helpful in understanding some clinical pharmacokinetics.

I had a decent leg workout on the new calf machine and 20 minutes on the new arc while I reviewed drugs. Then I did videos on antibiotics and bacteria for several hours.

My scheduling worked well for today. Tomorrow after the hospital I'm going to polish up my pharm lab, smash some pathophys, and pharm - hopefully I will get around to a good long yoga session before revising my BSFCR and firecracker. Tomorrow is my first day interacting with real patients in a real hospital. Although there will be at least 5 other students with me and the patient, I anticipate that it will be a good experience.

Tonight on the bus I talked to some of the people involved in the operation of the ICM department...which is a strange class bridging the world of theory into practice so we don't go in cold to the clinics in the USA. Learned many things.

Introduction

Time is passing and I keep growing in ways I didn't think possible. This journal is for 2015 and all the wonderful gifts and challenges it brings. Events are happening - and I want to take moments out at least once a week to be thankful for what has happened.

Since last Sunday I studied 700 firecracker questions and reviewed two and a half USMLE lecture series for repro and rheum/derm. There were some USMLE practice questions and First Aid drugs mixed in. I kept up with lectures, attended a required lab and got a feeling of how the pace of this term will go.

Two nights this week I had the privilege of staying with the gorgeous Puerto Rican vet student. We laugh, kiss, dance, and share thoughts. It's excellent to connect with someone else in that capacity. She gets compliments whenever we are out. Last night we were having some fantastic drinks while we talked in Spanish (I mostly listened) about her frustration with a physiology course. The mood lightened eventually and we joked about everything.

Time is so precious. Friday I was able to enjoy a bit of it with Aaron, Louisa, and Dan while we got food and drinks at options. The chicken wraps on this island are my go-to choice to pick me up. After a little time there I worked out -- the gym has better machines! It's fantastic to hop on a smooth arc machine with a working touch screen and smooth strides.

Clarity is coming! I joined a facebook group recently about the clinical programs in Toledo. They raved about the program and several people said it was an excellent idea to go there. It will be nice to be near my sisters and to be able to enjoy catching up with some people around Ohio. There seems to be enough to do there that I will be able to stay busy. All the rotations except psychiatry are in one place.

Last week I got to salsa dance with a fun group of people. There was a good mix of students, friends, and locals. It was an hour of review for all of us, but mi chica was enjoying it a lot - so we got to practice more. We practiced on the rooftop of Bourne at night. Fireworks went off over Calivigny and we kissed.

Friday night was an excellent IFMSA dinner with the incoming board. The transition out of communications director will free up a lot more time to help with SCORA projects.

I am about to schedule the next two weeks so that focus and clarity can help me with the tasks ahead.
Things are well.