But the other reason I was dreading it, is because I didn’t want to face a reality I’ve been trying to ignore. And that reality is one I’m trying to avoid facing every other weekday too.

You see, I am just not loving this clinical.

There’s nothing wrong with the facility, the people are fantastic, the patients and families are great. I just am finding out more and more each week that this setting isn’t for me. For 3 years I’ve told everyone that when I graduate, I’m going into pediatrics. And now I’m realizing that I’m not sure if that’s at all what I want or what will happen.

And it’s just a weird thing to face each day. And I get to face it 5 times a week for the next 10.5 weeks. I just don’t love it. I don’t love the diagnoses I face, the treatments I’m creating/managing, etc.

I loved my last affiliation. It was an outpatient setting, primarily with adults, but I was fortunate enough to see many pediatric patients while there, which, incidentally, I loved. Minus a small sexual harassment issue (I was on the receiving end, not giving, just for clarification) I would happily go work there (and they pretty much offered me a job) after graduation (and baby and boards), but I feel this odd sense of…guilt.

I feel like I’ve led everyone astray somehow. Like by saying now that I don’t think I want to do pediatrics, I’m changing what everyone thinks about me. Like by saying I’d maybe rather work in an adult or adolescent setting, I’m disappointing the people who have educated me, who have supported me.

I know that isn’t necessarily the reality, but it’s the way I’ve been feeling. And so I don’t want to get up in the morning and go to clinical because it’s just a reminder of this feeling. It’s just a reminder that I’m not quite as sure of my path as I thought I was. That despite being a meager 14 weeks from graduation, I’m not sure at all what I’m going to do after that. Minus the baby part, obviously.

And just like the past few nights, I really wish tonight wouldn’t end. That tomorrow’s alarm clock won’t go off and that I can just stay in bed, at home, and bury my head in the sand.

I’m just not ready to face the uncertainty ahead.

I arrived on time and found out that I was one of 5 students starting today, including one of my classmates. We all did security stuff, got parking permits and then spent 2 hours reading through very thick binders of information about the hospital. Once all the forms were signed, I found my clinical instructor (CI) and we chatted for a few minutes.

She warned me that the first patient we were going to see was a very unstable baby with some other issues I’m not going to divulge. She offered me the option of going to lunch instead, but I decided to stick it out and eat lunch after. Though I grabbed a granola bar because I didn’t want to pass out.

And yes, the patient was…intense. I spent a lot of time reminding myself to breathe, bend my knees and relax. And I did fine. I ate lunch and then we went and saw a few more patients.

I got to hold and assess a couple of (stable) babies, I learned a ton about various aspects of NICU care and was really enjoying myself. My CI offered to let me leave at 4, but I told her I was fine to stay until my arranged time of 4:30 and so we went to see one last patient. This patient wasn’t in the NICU, he was a full-term infant in the normal hospital rooms with his mother. Basically, he was the lowest stress, most stable patient of the day. And all I had to do was listen to my CI explain something minor to the patient.

After about 10 minutes I started to get really warm. I have to wear a white coat and unlike everyone else, my only white coat is long sleeved and goes down to my knees. A few more minutes passed and I was getting more warm. The gloves were not helping. The room was stuffy. I was not handling things well. I wasn’t stressed, but suddenly I knew that I needed to get out of the room.

So I washed my hands quickly while my CI finished up and I stepped out in the hallway. By the time I got outside my vision was tunneling and my hearing was almost gone. I took my coat off and fanned myself but it was clear where this was going. After the longest few moments of my life, my CI came out into the hallway and I told her that I was going to pass out.

She got me a chair and some juice and after about 3 minutes, I was fine. I mean, I had a horrific headache and I was so tired I wanted to go to bed for the day, but I was no longer light headed, I could hear and see fine and I wasn’t hot anymore. The passing out danger had passed. I was fine. I was just HUMILIATED.

My CI told me that this has happened to all the pregnant women who’ve been in the NICU, which should make me feel better, but all it really makes me feel like is that I have 16 more weeks of freaking out about passing out every day. It’s so frustrating because I LOVED this day until those last 5 minutes. It was so neat. And now I’m home, exhausted to my core (it’s so ironic to me that losing consciousness is so energy draining) and even more worried about going back tomorrow.

Realistically I know the steps I need to take. I bought a short sleeved white coat, I will carry fruit snacks with me to keep my blood sugar up, and I will sit. But I also feel like I went from being totally in control to as out of control as I could possibly be. I guess it was good to learn this lesson early without actually passing out, but I would give anything for a do-over right now.

And to go back to the peace of mind I felt at 4:25 this afternoon instead of the crushing exhaustion and embarrassment I feel now. It’s gotta be uphill from here, right?

Technically I’m only in the NICU on Tuesdays, Wednesdays and Thursdays, while Mondays and Fridays I’m working in an outpatient pediatric clinic, but the bulk of the time, especially with holidays, will be in the NICU. I am legitimately nervous about this.

One part of my nervousness just comes from the delicacy of the patients. I have done some very limited work in a PICU, but I’ve never worked with anyone as medically fragile as these babies will be. And it’s kind of alarming to realize that any mistakes could be not just unpleasant but life threatening. Now, most likely I won’t really get to do a lot of hands on stuff, at least not without extremely close supervision, but that doesn’t make it any less frightening.

The other part is obviously the total mental mindfuck that is being pregnant in a NICU. So far I’m feeling relatively okay about it, but only time will really tell with this one.

And more than anything else, I’m sad to be finished with vacation. I really, really love vacation and this was the last one I’ll ever really get. I mean, the last child free, relatively care free vacation of my life. Or at least for like 20 years. That is a long time from now, in case you’re not big on math.

I had planned a quiet day today to get all the last minute things ready for tomorrow, which meant that absolutely nothing went according to plan and today was the exactly opposite of relaxing. Maybe in the end that’s a good thing since it means I haven’t had time to worry too much or to get too bogged down thinking about anything. I’ve had to focus on other stuff like my nieces, my cat being a tremendous asshole and putting together a crib. But now I’ve got 2 hours before bed and I’m starting to feel unsettled.

There is a small part of me that is excited, it’s a new experience and it may be something that I want to do for the rest of my life. The prospect of that is exciting and scary. And even if it’s not something I want to do forever, in 16 weeks it’s over, and I’ll be ready to graduate.

It’s 16 weeks, 79 days. I firmly believe that I can do anything for 79 days. So we may as well get this show on the road.

In my last semester of graduate school, the one that is supposed to be the toughest, I got straight As. I can’t emphasize enough how rigorous this semester was. It was supposed to be basically he culmination of all 3 years and the final exams I took were basically 3 years of information in two hours. It was intense. And I got straight As. It feels nothing short of amazing.

I still have one clinical affiliation between me and graduation in May, but my graduating GPA will officially be a 3.74. It’s not too shabby considering how close I came to quitting 2 years ago over fears of failing.

Suck on that headaches.

I am kind of gobsmacked by this realization.

I texted my friend and she replied that she remembered 2+ years ago when I called her, on the way home from school, to tell her that I had decided to quit. I remember it too. It was after I had missed several weeks with a spinal fluid leak. I had missed a major midterm and so much class. And they wanted to do another lumbar puncture that would knock me out of school for at least a few more days.

That night I called my program director to tell her the same thing. I was ready to quit. I just didn’t think there was any way I could do it.

But I did.

As I was driving home from school on Thursday, a song came on my iPod and I heard the words in an entirely new way.

“And high up above or down below
When you’re too in love to let it go
But if you never try you’ll never know
Just what you’re worth

Lights will guide you home
And ignite your bones
And I will try to fix you”

School, this career was something that I have wanted to do for as long as I can remember. I hated the idea of quitting because it was something that I wanted so badly, something I loved from the first moment I started. I was convinced that I couldn’t do it and so I wanted to quit before I could fail.

But because of the people in my life, my husband, my family, my friends and many of you, I didn’t. I found out what I was capable of.

You are the lights.

You have led me.

You have ignited me.

You have fixed me.

And now I am home. I am finished.

And all I can say now is thank you. I couldn’t have done it without you.

At this point there is literally only one test standing between me and graduation and it’s not until December, so I can safely procrastinate for several months. There’s a presentation sandwiched in there too, but those are always manageable.

The exams today went fine, they were all pretty much exactly what I anticipated. But something kind of cool came out of them. I realized just how far I’ve come in this process.

My first year of school was all about details. It was about numbers, it was about the very nitty gritty details instead of the big picture. And today I realized that I have gone from memorizing details and regurgitating them on tests to actually understanding processes. Today’s tests were very much still about knowing the details, but it wasn’t about plastering them on paper. It was about understanding what they meant. It was about knowing what those details added up to.

My oral test today was a patient case where the diagnosis was incredibly uncertain. In my first year of school that would’ve killed me. Because the first year was a year of black and white. You had condition x or condition y because those were the options. And I’ve since learned that sometimes it’s neither x nor y, sometimes it’s both x and y and sometimes it’s half of one and a quarter of the other. I had to defend my potential diagnoses and I was able to do it, intelligently, without stress and without killing myself studying for days.

The practical exam was similar. I no longer stand in front of instructors with trembling hands. I didn’t have every single answer on the tip of my tongue today, but I had the tools to figure the answers out and I think that ultimately, that’s better, it’s more practical and more realistic for long term practice. And when I didn’t know the answer today, I remembered that sometimes that’s reality. Sometimes even the most expert clinicians have to look things up.

Admittedly there were a few skills I could’ve done better on, especially toward the end of the test, but I was able to problem solve, perform complex skills without help and answer most of the questions about them. And I got feedback so that I can continue to improve.

It’s such an odd feeling, the lack of stress in exams. I was appropriately scared of the unknown, but not panicked. I knew that I had learned the material, I knew that I could manage the questions if I just took my time and thought it through.

And now it is done.

Now there is only one test left. There’s only one more day where I’ll stand up in front of instructors and perform techniques. Where I’ll justify my assessment or treatment. Where I’ll get feedback, get some praise and some suggestions. I might sound nostalgic for the days of testing, but it’s really more just amazement at how the time has passed.

Of how far I’ve come in my learning, in my confidence of myself.

And of how little time I have left to go.

I received an iPod as a gift a few years after my iBook and from there, the love affair really blossomed. I received another iPod as a gift and still use it today (the first one, also stolen on my honeymoon) for exercise. I’m on my second iPhone and I believe I am now completely non-functional without it. It’s like an extra lung or something. I cannot live without it at my side or my pocket or in my hand. I actually even had a dream about the catastrophic possibility of breaking it last night.

We’re also the owners of two Apple TVs. In a word, we have an addiction. We don’t really spend money on clothes or on fancy dinners, we spend money on Apple products. We save our money and then we buy what we think are the best.

Because our funds have been short lately, especially after the unexpected need to replace a car, we’ve not been in the market for Apple products. We both look longingly at the Apple website at the new computers and the iPads, but we just don’t have the money. And we’re grown ups, so we only quietly cry ourselves to sleep. First world problems are hard too, guys.

But today? Today I got an iPad.

Only, I didn’t have to pay for it! And I don’t get to keep it. And I can’t install Angry Birds on it. I know, that last part is pretty much the low point of my day.

Let me explain. I’m participating in a pilot of a pilot study (that I helped design), to determine the usefulness of technology in clinical settings. Our goal is to see if tablet technology improves on our standard of care and influences our use of evidence to drive patient treatment.

(Didn’t that sound all official and stuff? I know, right?)

And in order to research that, my school decided to provide me with an iPad. An iPad pre-loaded with the apps I asked for (minus Angry Birds…), all of which are relatively pricey but totally awesome for my clinical affiliation right now. They’re paying for my service as well and in exchange, I just have to, well, use it. And document that I’m using it. I’ll be meeting with a mentor every few weeks to discuss what is and isn’t working. Not too bad for free usage of an iPad for at least 4 months.

The end goal is either to publish our results in a journal or to do a presentation in February at our national conference, but both are dreams that are a bit down the line and there’s a lot of work between here and there. But we’re excited, and not just about the fact that I think I’m now currently in possession of every Apple product ever made, but also about making an impact on the future of my profession and about studying something that could positively impact future clinicians.

But you know, also the iPad.

EVER.

I know it probably doesn’t sound like that big of a deal, but save for one semester between getting my teaching credential and beginning my night classes to finish pre-requisites for graduate school, I have been in school continuously since I was 4 years old. 24 years of school is a lot of school. And I am ready to be finished. Beyond ready.

Next year at this time, I’ll have taken (and hopefully) passed my boards, I’ll be a practicing clinician, hopefully gainfully employed somewhere. I’ll have the last degree I ever plan to get, I’ll be a real adult. Finally.

I have had a lot of days that I thought were my last firsts. I didn’t envision going back to graduate school after I finished my credential, but most days I am so glad I did. I’m going into a field that I love.

My first day of clinic was uneventful, just long. I spent the day observing my clinical instructor (CI) who is extremely nice. His wife also works in the clinic and all the other employees were lovely and polite. I felt comfortable with the types of patients that I observed my CI treat and I’m going to actually be treating patients as early as tomorrow.

Yesterday and today were some of my last firsts. There will be a first day of work and many firsts once there are children, but for now, all that lies in the immediate future are lasts. Last midterm, last final, last semester in school.

There are still 8 months until it’s all over. But this is the beginning of the end. The last firsts. And I’m pretty excited about it.

And of course, some first day of clinic and school pictures, for my mom. I wish I could say that my self photography had improved since last year, but uh, that would be a lie.

I spoke with my mentor a few weeks ago about my clinic hours. Basically, I expressed some concern that being in the clinic M/W/F from 8-6:30 and commuting 60 miles for school from 8-5 on T/Th might be a little too much for my body to handle. The majority of my classmates who are doing their part-time clinical in the fall are only in the clinic for about 8 hours a day, instead of the 10 I am lined up to complete. So with my mentor’s suggestion, I emailed the director of clinical education.

It took him almost two weeks to get back to me, but when he did he informed me that though he’s not wild about it, 10 hours days during part time isn’t against the rules. He said that if there was some reason, other than fear of falling behind in my classes (because we’re all going to be afraid of that, whether 8 or 10 hours) that I need shorter days, that I can ask for them.

So I’m torn.

He and I discussed my medical history because I hadn’t really given him all the details. I tend to keep things quiet with instructors who don’t really need to know the details and it turns out that this time, that was a mistake. If I had been up front with him sooner, he could’ve placed me in a clinical where I wouldn’t have to ask for 8 hour days. Which is frustrating.

The result of our talk is that it’s really up to me. It is reasonable for me to talk to my clinical instructor and explain what I think I need and why, but I also don’t have to do it and no one is going to do it for me. And I really don’t know.

On the one hand, I don’t want to perform poorly on my clinical because my body can’t handle 36 clinic hours a week plus 16 hours in school. But on the other hand, I don’t want more accommodations, I don’t want to have to disclose my medical history to a stranger while I’m trying to make a good first impression. I don’t want him to think that I’m not going to be able to perform or that I’m a whiner.

I really don’t know what to do and it’s been weighing heavily on my mind. I have a phone conference set up with my mentor tonight, so hopefully with his help I’ll figure out a plan. My first day is a week from today and boy would I like to go into that with a little less stress than I’m feeling now.

In other school news, I celebrated a small victory today. Granted, it was only the summer semester and it was only 3 classes, but for the first time ever (in graduate school), I got straight As. Not even an A- among them. And that class that I got a low grade on the midterm? Apparently I got a perfect score on the final exam. This wasn’t an easy summer, in fact, it was a relatively awful one in terms of pain, and so I’m really proud of the result.

Hopefully the rest of the school worries will follow suit and ease up a little.

I never turned them in.

I’m not sure what possessed me to not do it, but I decided I could do the test in the allotted time like everyone else. Even though I had a feeling I couldn’t. Pride is a funny thing. It’s also a bastard sometimes.

The test went poorly. Which is frustrating since I’ve been doing really well in the class discussions (it’s Differential Diagnosis) and assignments. I could tell when my teacher handed me my test back today and realized that the score I got belonged to my ID number that she was surprised. It was bad. I did really quite badly.

It wasn’t because I wasn’t prepared. It wasn’t because I didn’t understand the directions. It was because I didn’t have the time to think through it well enough. It was because my brain was moving too slowly that morning and I could not get done what I needed to. When the teacher called time I had managed to get each box filled, but not well, not nearly as well as I could’ve if I’d had even just 10 more minutes, not even the full extra 60 I’m allowed.

And I just cannot stop kicking myself.

What was I thinking?

Why didn’t I just hand over the paper and take the test the way I’m allowed?

Now I have the final exam for this test on Thursday and it’s going to be a fight to get even close to the grade I want, to the grade that I truly think I deserve based on the work I’ve done and my participation in the class. I have worked so hard and this exam and the score don’t even begin to convey that. It’s one of the worst grades I’ve ever gotten, especially in a class I feel that I understand as well as this one.

And worst of all, two of the instructors of the class are ones who know me fairly well and I feel almost embarrassed. I feel like I let them down, like I look like an idiot. I know I can do better, I know I should do better. I emailed one of them to ask if I could still arrange to get extra time for the final, even though it’s in 3 days and I’m waiting to hear back. I know that there’s a good possibility that the answer will be no and there’s nothing I can do about that. I’ll just have to do the best I can and hope that it’s enough.

And I’ll have to remember this lesson. Remember that it’s okay to accept help, that it’s okay to need it sometimes. And it’s okay to admit that to others too.