Archive for the ‘The Graduate School’ Category

One month from tomorrow I officially begin my third and final year of graduate school.

Actually, 1 month from tomorrow, I begin the first day of my 16 week clinical and 1 month and 1 day from tomorrow, I start my first day of classes. In our 3rd year, our class is split in half. One half of the group is in the clinic 5 days a week for 16 weeks, the other half is in clinic 3 days a week and in class the other 2 days, also for 16 weeks. In the spring, our groups switch.

I actually found out about my placement a week ago and I have had mixed feelings, but they were made less mixed today.

I have made no secret with our director of clinical education that my interest is pediatrics. I have repeatedly requested a specific setting and I have quietly and politely waited. And of course, I didn’t get it. And I have already been tentatively placed in the spring in another setting, so no preferred peds setting then either. The spring setting is one that I’m actually interested in, but it was one that I had hoped to do for a significantly shorter clinical. I’m grateful for the opportunity next Spring because most people in my program don’t get to do this, but once again, I don’t get to do the peds setting I wanted to try.

And sitting in the classroom as everyone excitedly got their placements, as classmates got their ideal clinicals was kind of sucky, but far from the suckiest part.

And here’s the problem, that peds setting that I don’t get to do is one of the settings I have long believed that I would want a career in. And now I don’t get to try it. So when I graduate next May and start looking for jobs, I won’t really know if I like it. I won’t know if I’m good at it. I won’t have any idea. I’ll be jumping blindly, or I’ll be jumping another way altogether.

And that just plain sucks.

The other sucky thing is that all my friends, literally ALL OF THEM, have their full time clinical first. While I have my part time clinical. So basically I’m going to school with none of my friends. I am not exaggerating when I say that I won’t even have anyone to eat lunch with. And while obviously I’ll find a way around it, it’s sort of salt in a crappy pre-existing wound.

I’m trying very hard to be positive. The setting I’m in in the fall will be fine. It’s one I’m relatively competent in (though I will need to do some serious reviewing in my 3 weeks off) and though I thought I wanted my full time clinical first, I imagine that it will be nice to be finished with classes forever in December. And the clinical in the spring is going to be very very cool.

It’s just, I’m growing tired of fighting to see the upside.

I would like something to go the way I want it to. I know this sounds silly and unnecessary and childish. And I know that all of this is magnified by the fact that my head absolutely WILL NOT stop hurting. But I am just frustrated. It feels like everything is more difficult than it needs to be these days. I want something simple and straightforward. And that is just pretty much universally never an option.

I’m going to try my hardest to keep my chin up and find the good, but for tonight, I’m going to eat some m&ms and be a little disappointed. And then I’m going to go to sleep and try harder tomorrow. And hopefully the bright side will be easier to see.

Tomorrow is the last day of my clinical.

Technically all my paperwork is finished and signed so if I was to suddenly be sick tomorrow the world wouldn’t end. Which is kind of good since I have a cold and am ultra-whiny right now and also because I want to be finished so badly I could cry. I cannot tell you how much relief almost being finished gives me. I am so entirely ready to walk, if not run, away from this hospital, this setting, it’s not even funny.

The people have been good, the facility is nice, and most of the patients are pleasant. (Though I totally got bitched out by one this morning. Tip: don’t piss off your healthcare providers, it will not get you anywhere you want to be.) The problem has not been this facility, the problem has been me and the setting. I am not cut out for adult inpatient care, it’s too stressful for me. The patients are not medically stable, they have huge sums of pain. It is scary a lot of the time.

The last two weeks I’ve been working with a different Clinical Instructor (CI) while mine has been on his honeymoon, which has been a bit chaotic. I’ve carried a full patient caseload independently, I’ve done all my own billing, progress notes, discharge summaries, etc etc etc. I’ve basically been a full time clinician. Only I’m paying to be there instead of getting a paycheck. Details.

This place has taken a toll on me. I am exhausted by the end of the day, physically, mentally and emotionally. I have seen enough tragic and sad things to make me want to run away screaming. I have seen patients make major gains, but I have seen others decline and even one just a few days before he passed away. I have run through so many emotions that I can barely find room to feel anything anymore. My dreams are filled with my patients, I feel like there is no getting away from the sadness I see.

By all accounts, I was good at what I was doing. My CI wrote on my evaluation today that he would hire me right now if he could, even though I haven’t finished school. It’s pretty much the best compliment I’ve ever received, I’m not going to lie. And though it’s nice to know that I was good in this setting, but I also know that I cannot do it as a job. I cannot work in hospitals with adults, I can’t see this kind of thing each day. I see my parents and grandparents and aunts and uncles in each of my patients. I see my future as a caregiver, as a family member with a sick relative. I know that there are some people who are cut out for this stuff, but I am not one of them.

And I am grateful that I got to experience this so that I now know what I’m getting into. I’m glad that I no longer have to wonder or even consider applying for jobs in this particular setting of my field, but I have to be honest when I tell you that these were some of the longest 6 weeks of my life. I have never been one to really look forward to school, but I’m so excited to start summer school next week because it means I’m finished with this clinical.

It has been a test of my mind and body and though I think I passed, I did so at a great cost. And I think it’s going to take a lot of rest and time to recover.

(As a totally unrelated side note my husband finished the first part of his 3 part residency today. He’s officially finished with general pediatrics and on to adult neurology (which, hell yea, can totally be used to my advantage). If you wouldn’t mind giving him a virtual high-5 for being 2/5 of the way finished with residency and done with peds, that’d be super.)

I briefly mentioned earlier this weekend that I am not loving my current clinical rotation. Initially, I couldn’t put my finger on what I didn’t like. The people are nice enough (though I spent the first few days eating lunch by myself because no one told me that there was a patio outside where everyone ate) and the patients are both interesting and challenging in mostly good ways.

When I was placed in this clinical I was told it would be an outpatient experience. Typically outpatient clinicals involve caring for more stable patients who don’t need to be hospitalized and though I’m not necessarily more interested in outpatient, it was just a shock to get there and discover that it was actually an inpatient facility. It’s a hospital, though not one with an ER and surgeries, it’s sort of an in between hospital where patients who still need inpatient medical care can go to get stronger before going home.

But that scenery change is not even the thing I don’t like. I worked in this same type of setting a few months ago, but with pediatrics and I absolutely loved it (like, want to work in that setting for the rest of my life, loved it). I just couldn’t figure out why I was dreading going back to the clinic each morning. And I finally put my finger on the difference.

Working in pediatrics is sad every day. Children aren’t supposed to get seriously injured, they aren’t supposed to have cancer or be very sick. It’s tragic and you go in each day knowing you’re going to make a difference, but that the situation you’re entering is very sad. In a way, you kind of metaphorically gird your loins for it and focus on what you can do, which with kids is often a whole lot. They have a potential for recovery that is just unbelievable.

In adult inpatient, it’s not always tragic, sometimes it’s just life. Several of my patients in the last week and a half have been very old, one was nearly 100 years old. And I have nothing against the elderly, in fact I find them to be a lot of fun to talk to and work with, but they are challenging to me.

They remind me of the future.

Many of the things they are struggling with are not anomalies, they are the result of aging. Of being normal, hell, of being healthy. These adults need help, need a high level of care, because they cannot look after themselves anymore. I look around and see a patient that reminds me of my Grandpa or my Grandma and I see that they’re losing their independence. I see that they’ve had to let go of modesty because they aren’t allowed to use the bathroom alone. I hear about their discharge plans to go to nursing homes, to have a home health aid stay with them at all times.

What I’m finding the most difficult about this clinical isn’t just that it isn’t in pediatrics (my real interest), it’s that it takes me to the future. It makes me think of my mother and father, of my husband and myself and what we will have to face. It is a reminder that sometimes people need help not because of some tragic accident or some gene that’s gone haywire, but simply because they lived long enough to have something break, or because they lived long enough that their body is starting to fail, even though the mind is sharp.

And it’s scary. It’s scary to see all the things that can go wrong after a lifetime of things going right. It’s hard to see how quickly health can decline, to hear about how a person was up and walking a week ago and now they can’t swallow their pills.

I’m sure we can psychoanalyze the crap out of this and learn about my fear of the future, but the reality is that it’s a challenge for me. I am determined to make the best of this clinical, to learn and to grow in my field. But it is draining. It takes a lot of energy to not get sucked into each story, to not get pulled down by the weight of what I see and hear each day.

I only have 22 more days at the hospital and I just hope I can continue to find silver linings, to learn from my clinical instructor and my patients and that when I leave there, I will have an even greater respect for life, for aging and for all the work that my patients and their families are doing each day.

So that whole, they are just classes thing? Yea, that attitude lasted like 3 days. I am now back in full crazy grade lady status and trying to figure out what changed. I have lost my zen.

I mean, I never stopped wanting to do well, that was always at the heart of these finals even when I was calm and able to see that they were just tests. But now that I’m halfway done, I’m stuck. I can’t get past them. The first one went fine, as fine as it could’ve. It was 4 hours of writing on a topic I could hardly care less about.

The second exam was in a class that I was doing REALLY well in. Like, exceeded my own expectations by so much I’ve been kind of giddy over it. And because of that, I put a lot of pressure on myself to continue to do really well. I took the written test this morning and there was one question that I really didn’t know the answer to. Like, I read it and had absolutely no clue. It was a short answer question and I don’t ever leave those blank, so I improvised and came up with a fairly reasonable answer. It wasn’t completely right and I know I’ll lose some points for that, but it wasn’t completely wrong either.

But I cannot let it go. I’m mad at myself because I didn’t take the time to study that article. And I should have. And if I had, I could’ve had a higher grade.

Then there was the practical. It went well. It was an ultra scary test because it was one where we worked with actual patients, patients who we had never met before. We got graded on our patient interaction, our patient treatment and our ability to tie what we had done back to what we had learned in the class. There were questions asked throughout and it was really neat, but also really stressful.

My patient loved me. He told my teacher that they should give me a job now. The praise doesn’t get much higher than that, and my tester gave me good feedback. But not great. The reality is that I missed an oral question that cost me at least a point, and my skills weren’t flawless, there were more points slashed there. In all likelihood, I will probably still walk away from the practical with at least an A- (or so I think, based on the feedback I got, maybe a B+), but I am SO mad that I didn’t do better.

I know this sounds crazy, I’ve always been this way. It’s not about doing better than my classmates, I could hardly care less what their grades are (except to help if it’s something I get and someone else doesn’t), but I’m mad at me. I feel like I just haven’t done my best because if I had, I wouldn’t have lost points. If I had done my best to study, I would’ve known the answer to all the questions. I worked so hard this semester and now I’m letting myself down at the last minute.

I have another exam tomorrow and I just can’t even bring myself to really study. I’m so tired, so burnt out and disheartened. To get an A- in that class I need a 96% on the final, which is cumulative. And I just don’t see it happening, which is really getting me down. Thankfully it’s not until tomorrow afternoon, so I have a little feet dragging time, but still, it’s hard to keep plowing forward when you just want to stop forever.

In reality, I know these are just grades, they are not the most important thing in any realm of my life, logically I know that. I also know that I am still doing well, that I am still going to pass my classes and graduate in a year, on time. But that doesn’t change the fact that I’m mad. I’m mad at myself. It’s not often that I let myself down, but tonight I feel like I have and I’m having more trouble than usual picking myself up and moving on.

1: the number of exams I’ve taken so far

4: the number of hours that one exam took, not including studying time.

20: the number of times I wanted to cry from all the writing.

2: the number of questions I already know I got wrong on that stupid test.

4: the number of exams remaining, including tomorrow’s 2 part exam.

10,000: my stress level over tomorrow’s exam.

7: the number of hours I would get of sleep if I went to sleep right now.

8.5: the number of hours until my written exam, which translates to 7:45 in the morning. Ugh.

16: the number of hours until my practical exam, which is most of the cause of my stress.

8000: the number of zits that have appeared on my face today, also the number of grams of sugar I consumed today.

15: the number of times I’ve noted today that my right hand smells like a foot thanks to this brace.

2: the number of days the monster headache I feel brewing needs to hold off.

6: a better number of days for the monster headache to hold off, if we’re doing wishful thinking.

13: the number of days of vacation I get when finals are finally over.

1000: the number of times I’ve coughed today.

1000: the number of times I’ve gotten subtle satisfaction out of coughing in front of my bitchy classmates.

10: the number of minutes ago I should’ve stopped writing this post.

My finals begin on Wednesday and all three that I have this week are cumulative. I can’t fit all the papers I need to study this week into a 2″ binder, in fact, I can barely fit just those 3 classes into two separate 2″ binders. I had no business taking a day off yesterday.

But I did it anyway.

I woke up at the crack of dawn and drove across town to walk beside some of my dearest friends in the March of Dimes, even though I did an absolutely miserable job fundraising this year. I held babies I have known for a few months now and others I had not yet snuggled. I talked with friends who I see often and others that haven’t seen since last year’s march, friends who hold a dear place in my heart.

I stayed until 10pm at one friend’s house, laughing with others around a dinner table. I got home after 11 and went straight to bed feeling calm for the first time in weeks. Almost no work was done yesterday. Finals were mostly forgotten.

And I do not regret it for a moment.

It is easy for me to sometimes forget about real life. I put school above most things, even above myself and my needs. And yesterday I chose to put the nourishment of my soul, my spirit, first. I laughed more than I have in ages. I talked with people who I care about, who care about me. If my husband could’ve come along, I probably would’ve deemed it a perfect day.

I resumed studying today feeling refreshed, remembering that these are just tests and this is just school. And there are bigger things in this world than that and that sometimes it’s okay to take a day off to spend time with those things. Sometimes it’s okay to take a day to be nourished by the ones you love, by causes you care about, by babies and mothers and friends and parents.

In fact, sometimes it’s exactly what you need.

Last week we had a meeting with the director of clinical education about our clinical rotations for our 3rd year of school. The 3rd year of our program is quite a bit different from the first two. We don’t have classes all day, instead, we have a 16 week fall clinical and a 16 week spring clinical. One of those is full time, 5 days a week. The other is part time, where you’re in the clinic 3 days a week and in classes the other 2 days.

And here’s the thing, a year from tomorrow, on April 20, 2012, I’m finished. April 20th, 2012 is my last day in the clinic, it’s the last day as a student.

I have been in school for 23 years with only 1 semester off in that time. And I have almost exactly one year left.

I can’t describe how this feels. The end is in sight. There have been SO many times in the past two years where I didn’t think I’d finish this. There were many times when I almost quit because I thought that would be easier than failing. But I didn’t quit and I didn’t fail. I succeeded. I have a really respectable GPA and as of this moment, I actually have As in all of my classes.

This year has already been so different from last year. Last year I was in survival mode. My only focus was on passing, it wasn’t on succeeding or exceeding any expectations. It was just pure survival. I just wanted to get through each class, get to the next break. This year, I know I can survive. I know I can pass these classes. And I’ve started to realize that I can actually do well. That I’m actually going to do well in this career and I’ve long worried that that wouldn’t be the case.

This year there is a feeling of relief. I will do this, I am doing this. And in a year, I will have finished. I will have accomplished what I set out to do. I will have accomplished what I thought completely impossible.

And yes, a year is still a long time, and there is a lot that can happen, but for the first time in a long while, I’m confident that I can handle anything that tries to slow me down.

One year to go. I can do this. I am doing this.

One of the biggest secrets I’ve scarcely managed to keep on this blog is the field in which I’m studying. And no, I’m not going to tell you tonight, sorry. But I have made not attempts to hide the fact that I attend USC. I chose my program for a number of reasons- they have a HUGE staff of experienced clinicians, they have labs with technology that regularly blows my mind and the people there are just wonderful. Well, I mean most of them, there are a few I could do without.

But here’s the thing, my program is widely disliked by people outside of it.

This has come about because of a number of reasons. For starters, my program is ranked #1 in the country, and many people think that ranking is wrong (for the record, I could hardly care less about our ranking. Seriously.). Second, not everyone who leaves my program is humble and lovely, many of them throw that ranking in the faces of others, though I’d say that’s not true of the vast majority of our graduates. We also have much bigger class sizes and our tuition is astronomically high.

So when I go to clinicals that aren’t at USC facilities, I expect some USC hate. It’s sad, but true. And this time has been no exception.

One day last week I was paired up with a different clinician so I could see a different subset of kids and she asked me where I went to school. I told her USC and then I saw the look. Before I said another word she began telling me about how she had applied there and almost went to SC, but honestly, the program was not that good, not worth the money and she discovered she could go somewhere cheaper and get the education she wanted.

I just sort of stared. This woman was standing up and defending herself, defending her choice of schools, even though I hadn’t even said a word that would make a defense necessary.

Her program is one I considered, but ultimately didn’t apply to. It’s a good program, but they don’t offer the doctoral degree and that was an important to me. If the doctorate becomes mandatory for clinicians in a few years (which is possible), I don’t want to even have to think about going back into a classroom, so I chose a doctoral program. But the thing is, I don’t judge her or make assumptions about her because of where she went to school, but I have not been afforded the same freedom of judgement.

Later that same day, I sat in an inservice, an inservice that was kind of awkward. I had just finished a unit in my classes on the topic of the inservice, and truthfully, I probably could’ve been the one giving it. At one point, someone asked a question and no one knew the answer. My clinical instructor turned to me and asked me if I knew.

I meekly said that yes, we had learned about this and described the method we had been taught. I chose my words carefully because I know that I am a student, they are experienced clinicians and I didn’t want to make things awkward.

As soon as I finished speaking, the woman I’d worked with earlier that day stood and said, “well, we were taught that it’s actually (this way).” And she explained the method she had learned. And just when I thought she was done, she looked my direction and said, “well, I mean, I didn’t go to USC, so take my suggestions with an inadequate grain of salt.”

WHOA.

To say that I was taken aback is the understatement of the century. I had no desire to get involved in any of what she was trying to pull me into, so I just quietly said that I really didn’t know what the right method was, I only knew what I had been taught. And for the rest of the inservice I just sat quietly, stunned by what had taken place.

I have never understood why people need to act that way. I cannot comprehend why she needed to make a dig at me, in front of the entire department, when I had not and would not ever say anything like that to her. I don’t think I’m better than anyone, I don’t think I’m going to be a better clinician, I just like my school. If tomorrow, they rankings were reposted and we were 101, I would still hold my head high, yell “Fight On!” occasionally and continue to work my hardest. It wouldn’t change a thing for me.

Because the education is all this has ever been about for me. And I just don’t have time to deal with hate. I have way too many good things happening to waste attention on the bad ones.

Last March, I had a 3 week spring break. I know, poor me. I spent part of it in my hometown with family, but I spent most of it laying around on my couch, relaxing.

While I was on my couch, my classmates were out on their first clinical rotation, the one I was supposed to be on too, the one I had all set up at a clinic in New Orleans. The very same one that the director of my program wouldn’t let me go on. Not because of my grades, in fact, my grades were good, but because after the last needle in the spine fiasco, I was told not to push, pull or lift more than 10 pounds for 2 months and that is kind of a requirement of my clinical rotations.

So I stayed home. And yes, I probably needed the time off, and I’m not going to pretend like I didn’t enjoy the relaxation, but it came at a cost.

Since last May my transcript has had a variety of A’s, A-’s, B+’s, one B and an incomplete. Technically, I didn’t finish my first year of graduate school.

And while it’s just a technicality since I’ve been able to continue progressing through the program and have passed all my other courses, it’s a technicality that’s been grating on me for a while. I wanted to be caught up and I wasn’t sure it would ever happen. Hell, I wasn’t sure I’d pass the rest of my classes, let alone make up those two weeks I missed.

Today, when I finished the last day of this first week of this clinical rotation, I officially caught up. In a few weeks when my transcript is updated, it will no longer carry an incomplete. And though that changes absolutely nothing in my academic standing and makes absolutely no difference in my overall school performance, it makes one big change in me.

I finished. I caught up. I did it.

The headache started less than 3 weeks before I began graduate school and it has done more than just hold me back in its 18 month tenure, at times it has nearly literally paralyzed me. It has caused multiple hospital trips, it has caused multiple invasive tests, most of while have required needles in my back, followed a few days later by more needles in my spine. It prompted my neurologist to tell me that I’ll need more brain surgery. This headache has been a personal hell for me, to put it mildly. But I feel like I’ve finally won a small victory.

Headache: 18 billion, Me: 1

There is still a considerable part of me that hates that it has taken 10 extra months to complete that clinical. I don’t like to be abnormal, I don’t like special circumstances or help. I just don’t. But the rest of me, the part that has been changed forever by pain, by frustration, by hospitals, needles and MRIs? That part is really freaking proud.

There’s no holding me back now.

I woke to my alarm at 5 this morning with a resurgence of hatred for this time change. Though, to be fair, 5 in the morning would’ve sucked even without the time change so maybe this was the easiest way to thrust myself into the new time. I showered, did my hair and was out the door and on the freeway by 6:15. Four freeway changes later, I was in the parking lot of a children’s hospital for day 1 of my 3 week clinical.

I was a little early, so I waited in my car and made sure I had all my stuff, and then I walked toward the door I was told to enter. I walked down a brightly painted corridor, following most of the directions (minus a few rights that were actually lefts) to the waiting area where my clinical education coordinator arrived a few minutes later. She took me to get a badge and key and then to sign a paper saying I didn’t have a flu shot (which is not because I’m opposed to them, it’s because I’m allergic to eggs). A few minutes later I met my new clinical instructor.

I put on a good show, but the whole time I was terrified.

Part of my terror is because I do not like hospitals. I have spent many hours in them and very rarely have those hours contained experiences that were even in the same universe as anything pleasant. But another part of it is because I think this might be what I want to do with my life and on the first day of trying something you think you want to do for the rest of your life, you tend to be a little scared. Or at least I do. I can’t speak for the rest of you.

As the day continued I got a tour of the hospital (which, by the way, is the MOST confusing hospital in the universe) and got to see 3 patients, all under the age of 7. Each one was so dramatically different, had a totally unique story and struggle and was a totally different experience to help treat. I got to see 3 different sets of parents doing everything they can for their child and I got too watch tiny victories for each of them.

I wish I could recount every detail and tell you all about what I saw and learned and all about these kids that I just wanted to squeeze and take home with me, but there are many laws that make that impossible, never mind that it would probably bore you to tears. But it didn’t bore me.

It invigorated me.

I know that I’m only one day into this clinical and I have no idea of how the remaining 14 days there will go, but for the first time in months, I remember why I’m in school. I remember why I’ve spent the past month studying my ass off, why I’ve given up everything that was give up-able, I remember why I started on this graduate school journey in the first place. It’s because of those 3 kids I saw today. It’s because of the work I was able to observe and do. It was for the bright future I got to contribute to and the role I got to play in the lives of children and families going through something tragic and scary.

I needed the reminder. I needed the motivation. For the first time in what feels like a lifetime, I’m looking forward to tomorrow. And more than anything else, I really needed that.