Simple Questions

Why does Friday take so long to arrive, but Monday is just around the corner?
Why are the most beautiful colors of fall actually a physical depiction of ending?
Why do the hardest struggles result in the greatest personal growth and deepest introspection?

Why is it that the simplest questions, are the hardest to answer?

It has been a pretty crazy last two months — I guess that’s to be expected since the last time I made an appearance here was at the start of August. That wasn’t actually a long time ago, but in so many ways, it kind of feels like a lifetime.

Things that have happened since then…

• I’ve taken 5 exams — 2 anatomy lab practicals and 3 much longer (neurology-related) exams of the multiple choice variety
• I’ve raced a half marathon — the fall Chicago Half Marathon at the end of September
• I’ve moved out of my first ever “big kid” apartment
• I’ve moved into my first ever “holy-crap-I-bought-this” condo
• I have a car (my hand-control adapted car) in Chicago that I can use to drive where I want, when I want, including making a surprise visit home after the Psychiatry exam last weekend.

Yea, just a couple highlights of the past two months (with some pictures to go with). I think there’s so much I could say about each one of those experiences that I don’t really feel the need to say anything. I guess that doesn’t make much (if any) sense, but sometimes “making sense” isn’t all it’s cracked up to be.

I love where I’m at — physically, mentally, and emotionally. I adore my new place and the fact I now have a bedroom and a patio. I’ve survived what most consider to be the hardest modules of medical school and am starting quite a few activities (classes, co-curriculars, etc) that I’m truly excited and passionate about. It’s a great place to be and it’s a place I intend to cherish and embrace. I guess that place I’m referring to is more related to where my head is than my physical person.

The last two months have been really challenging. Don’t worry, nothing crazy has happened. My family is doing well. My health is as good as it always is. I’m financially stable and still surrounded by so many great friends, colleagues, and mentors in the Chicagoland area. Yet, the day to day grind of life that never seems to stop, information you need to learn, assignments you need to complete, random to-do list items that won’t do themselves — was draining. I was exhausted. Stressed. Burnt-out.

It’s embarrassing to admit that. To recognize that I can’t always “do it all,” that I’m not some infallible being, that I have a limit to what I can manage, and I found where that limit lives.  We talk about wellness and taking care of ourselves in med school all the time. I think I was listening to all those conversations, but I don’t think I was really listening.  I don’t think I was processing through the obvious knowledge that the things we hear about in our lectures and see in our “medical life” can impact you in unexpected ways. Psychiatry was definitely a module of surprise and (slow) realization.

Let’s Face It

August 4th is technically still summer in Chicago, but my reality says summer ended on Monday. Ooft, that sounded a tad depressing. What I’m trying to say is that med school classes started again and I have officially returned to campus as an M2. Gone are the days of wandering along the lakeshore and reading romance novels  (8 books in July, although I promise some were non-fiction — I lead an odd life for a women in her mid/almost late 20’s) and I’m now back to the grind of powerpoint slides, ridiculous numbers of flashcards, and a substantial increase in my daily caffeine intake.

Yea, I guess the explanation didn’t really help to make things sound less melancholy, but in all honesty, I was ready to go back. Well, on Monday I was ready to go back…now, well…  I’m just kidding (mostly). It’s nice to get back into the routine of lectures, clinic, and extracurriculars. It’s exciting to be introduced to all of this new information (although a little less exciting to realize how soon my first exam is). It’s great to reconnect with friends and classmates and hear some of the amazing stories and experiences that filled their summers. In summary: Life is good and I’m already exhausted. I’m so glad I like coffee.

This year, things are a tad different. First off, I’m way less clueless about what I’m getting myself into and am about to experience. I know what’s expected of me and (generally) how to achieve it. In some ways it’s nice to be a second year student; but it’s also a bit more intimidating since there’s a whole class of 140+ first year students who think you know things (which may or may not be accurate). This year is also a little different in the way our curriculum is structured compared to prior years, in that our first organ system module is “Head and Neck. A two and a half week block where you’re supposed to figure out and understand the muscles/vasculature/nerves of the face and neck, the physiology and pathophysiology of the eyes and ears, and then a bunch of random odds and ends that could be considered neurology but you need to know to understand everything else. Putting it mildly, it’s intense. Needless to say, I spent a good portion of today silently envying Ingrid’s to do list.

Yet, I think the intensity of this module is about more than just the sheer amount of information coming at us on a daily basis. After all, I’m relatively used to that… it’s always a little different since the topics themselves change, but all in all, I expect feeling constantly behind and invariably busy. That’s a type of intensity that’s assumed. I think the challenging part of this module in particular is the actual subject matter, or maybe it’s the process by which we, as med students, learn it. 

How a-MUSE-ing

Summer is awesome. Period.

I don’t think that’s a statement that would shock very many people, but I feel as though it needed to be said. I also think there’s something about this summer, specifically, that makes it even more awesome. Perhaps it’s the sharp contrast between school year responsibilities and summer obligations. Maybe it’s the realization this summer is in essence, my last (most likely, ever) “between school years” summer. Then again, it could be that I now find myself in this remarkable position of living in a bustling city I’ve come to know and love with a close community of peers (who have become treasured friends) only a text and short walk away.

It’s awfully exciting to say the least, although I guess I should clarify that I am actually doing something this summer and not just spending it on the patio reading various books (although that tends to be my typical weekend activity). My day-to-day is usually spent at school in lab where I’m in the process of deciding exactly which lab I’d like to join for pursuing my PhD. I’m really loving it and am becoming increasingly enraptured by the science I’ve been able to learn and experience. I’m likewise pretty thrilled by my ability (at this stage in the game) to leave lab at a relatively “normal” time and actually leave lab – meaning I don’t have to go home and study for hours on end.

So where does that leave me? Well, it leaves me with a lot more free time than I’m used to having. Relatedly, it also leaves me with a greater appreciation for said free time. Time to explore various neighborhoods. Time to attend a small share of the countless live music fests that happen throughout the summer here in Chicago. Time to drink a beer on the patio with a close friend or group of friends. Time to stop, reflect, and muse.

Muse. I’ve been doing a lot more of that recently. You know, that unique type of calm and contemplative thinking that only happens in the arena of an untroubled and easygoing existence. That type of thinking where you aren’t really trying to answer a particular question and have little (if any) interest in reaching some extensive and esoteric conclusion. Instead, you’re just thinking, well, I guess you’re musing — about life, about experiences, about the way things are, and about the way things aren’t.

Milestones

Milestones — we all have them. Graduating from high school. Buying a first car. Maybe getting married. All those little things that mark “progress” through life. Today marks a unique milestone in my life, one of those milestones I imagined reaching at some far off point in the future, but not necessarily believing it really would happen. Today marks my 5 year anniversary of living life as a paraplegic post-spinal cord injury.

5 years.

I’m not exactly sure what it is about that length of time, but it carries more weight than any of the past yearly post-injury anniversaries. I was google-ing 5th wedding anniversaries and it seems as though that’s the year where you seem to transition from newly weds to “you-should-have-this-kind-of-figured-out” weds. Also learned during that google-ing session: you know how there is a particular item/material associated with every anniversary year? Silk, crystal, china, pearl — all that kind of stuff? Well, guess what year 5 is…. Wood. It’s wood. Boy did that give me a chuckle. Oh the irony, but back to my point.

Five years is one of those imaginary but very real “line in the sand” kind of time frames. It’s a length of time that carries with it certain expectations, expectations about what you should be able to do, what you should know, how you should carry yourself, how “moved on” you should be. Five years means when someone asks you when your injury was or what your story is, you can’t say “Oh, I haven’t been in my chair for very long” because actually, you have.

60 months.

It’s a surprisingly long period of time, and yet it has gone by rather quickly. Well, I guess looking back it feels like it went by quickly,  but there were definitely months where that wasn’t the case. A flip through the journal I kept as I processed through so much loss in the early stages of my injury is pretty sobering…

“Sometimes it’s hard to know where to start. I hurt so much, and in ways I never thought possible. I can’t wrap my mind around what I’m going through, and I don’t even know where to start. “

Even though those thoughts were written so long ago, I remember the fear, the anger, the stress, the utter exhaustion that accompanied each and every pencil stroke.

“I pray for God to give me strength, to help me work through all of this, but sometimes I don’t know where He is. I don’t know where to go for comfort.”

Whirlwind

Whirlwind: the only word I can think to use to describe the last four weeks. I’m certainly not complaining, especially as I sit outside on this gorgeous day on the other side of my anatomy lab practical. If you have no idea what an anatomy lab practical is, no worries, I (and I would guess a fair number of my classmates) didn’t really know what it was either until we actually took the thing. Spark notes version: you rotate around the anatomy lab at the command of a timed buzzer and identify structures, innervations, and/or function of various muscles/nerves/vasculature that are marked in the cadavers.

Since the exam was Friday, part of this weekend involves remembering what it feels like to relax and be normal-ish, like taking time to pause and watch the sun set across the lake just because. The “ish” attached to normal exists thanks to my wheelchair’s attempt at being funny when I got a flat Saturday morning and had to do some wheel swapping and make a trek to the bike store (I’m strong, but my fingers just can’t get that darn tire off). I don’t think I’ve ever been more grateful for spare tires and my type-A “must-be-prepared” personality. I’m also really grateful it happened on the weekend so I had extra time to get things taken care of…

You know, I guess that reminds me of a conversation I had recently about how interesting the way things happen can be. I mean, everyone has a story, but have you ever stopped to think about all the little pieces that must fall in place for that story to be written in exactly the way it has been? Even starting at the beginning, the story of how a person’s parents met, fell in love, and had a child — the person you’re talking to — is chock-full of “things-that-could-have-never-happened” happenings.

Beyond just finding people’s life stories embarrassingly fascinating, I guess I got to this line of thinking as I consider just why this last month has been such a whirlwind. After all, med school is always busy and a module on the musculoskeletal system (even with a bunch of anatomy labs) shouldn’t inherently be that different. But it was. You see, beyond just learning about muscles, this unit has a unique focus on patients and persons with disabilities.

Understandably, that’s a topic I find to be pretty important. At the same time, identifying so personally and so obviously with a “pathological state” that was going to be discussed over and over again as I sat in the front row of the lecture hall (not on purpose — I have a stair vendetta), well, could possibly be challenging for a number of reasons. What if I didn’t agree with the information being presented? What if things were lectured on in a way that I didn’t feel accurately portrayed the life, challenges, and interactions with healthcare for me and my disabled peers? Plus, how will my classmates take everything? Will it change the way they view or treat me? Will they feel like they’re “walking on egg shells” around me or not know how to deal with the “wheeling elephant” in the room?

Number 2

It’s always exciting to get a new pair of shoes. I should know, I only buy shoes once every 3 years (and that’s not even exaggerating…). Although, just for the record, when I was walking I was one of those people that would go through a pair of tennis shoes ridiculously quickly — I tend to be pretty hard on most objects/clothing, something that didn’t exactly thrill my mother, but anyways back to new shoes.

Yea, my poor chair has been through the ringer. Sorry bearings…

You slip your foot into that brand new shoe, feeling the unworn sole and stiffness of the heel yet to be broken down or molded to the shape of your foot. You lace up those crisp and bright laces, noticing the total absence of scuff marks on the shoe toe from the occasional stumble. I’m pretty sure it’s hard to not feel a little extra special the first time you “go out into the world” with those shiny new shoes, all sharp and pristine. It’s like they add something different to whatever you decided to wear that day. But then again, they are different. And they take a bit of adjusting to. After all, they haven’t yet reached good ole faithful status.

Okay. so what’s the deal with the shoe talk? Well, I’m attempting to make this relatable — at least in some small way — so that was an attempt to quote “frame your thoughts.” Why am I bothering with that? Well, I got a new wheelchair. Yea. Brand new. No scratches. No handle bars (I upgraded :D). Higher side guards (so maybe I’ll be a tiny less filthy when it rains/snows). Fresh paint. Brand new wheelchair.

It’s a pretty big deal to finally have these new wheels in my possession, and I guess that’s for a number of reasons. For starters, it’s been a bit of an adventure going from getting fit/measured for a chair to the chair actually being order to then finally receiving the chair. To make a really long story short, I started the process in October and here we are quite a few months later. Now I have no intention of bad mouthing the company I was working with. Actually, through a unique combination of personal connections, phone calls, and letter writing, I ended up having lunch with the CEO and sharing my experience and discussing opportunities for improvement. It’s really cool when companies are actively seeking and truly trying to be better, and it’s pretty awesome to have the opportunity to be apart of that process (even if there may have been a lot of frustration within a rather busy med school life along the way…).

Another reason my new wheels are a big deal — this is my first wheelchair order outside of the hospital back when I was in my acute, inpatient, super clueless stage. I’m a lot more familiar with how my body works and doesn’t work, things that I like and don’t like in a chair, and what chair features can make my life easier or harder. So yea, there are a lot of perks to being “not in the hospital” and this being chair #2. But at the same time, this is chair #2 and that carries with it a bit of extra baggage.

It’s Personal

February — it’s kind of a gross month. No offense to anyone that really likes it, but to me, you’re in the real dregs of winter. Now I don’t mean that in the sense like it’s almost done and over, similar to the dregs you find after almost finishing a good cup of coffee, but more like “Ugh, coffee dregs that probably have gritty coffee grounds in it — I don’t want to drink that, gross.” Yep, that’s my general opinion of February.

If you’ve seen the weather for the Midwest in the last few days, it’s been pretty nasty. Cold (expected) and wet (expected, but really not appreciated). We had a bit of a winter storm that dropped 7ish inches of snow starting late on Thursday night and the sidewalks and countless snowed in cars sure show it. Needless to say, I’m pretty thrilled it’s the weekend and have spent a rather large proportion of my time at home. Ingrid seems to be okay with that and has taken to a new habit of demanding affection at less than perfect times. It’s definitely a good thing she’s cute.

But enough weather/season talk… We started our Pulmonary Module two weeks ago and I have to admit, it’s exponentially more enjoyable than cardio was. We’ve had some amazing teachers for both organ systems, but I definitely connect more with pulm — not that I understand all of it, but it seems like much less of a chore to try and figure things out. But if I’m honest, I think my enjoyment of and connection to pulm is for mostly personal reasons. They say experience is life’s best teacher, and I kind of think the same holds true for learning medicine.

These last two weeks of lecture have brought about a lot of reminders and stirred up quite a few memories. To most, an example given by a lecturer to explain various blood gas concentrations in a patient that is on a mechanical ventilator (a machine that breathes for you) is simply that, an example. To me, its a flashback. A flashback to personally being on a ventilator, connected to endless tubes going to all these different machines, controlling the inspirations and exhalations of my body down to the last milliliter of air. I will say, learning how seemingly minor changes in ventilator settings can dramatically alter the physiology of the body — it’s a bit overwhelming to know that five years ago, I was that patient.

Feel that?

Look at that. Look at what you ask? I’m on the other side – the “it’s finished” side – of my first organ system module of medical school. Cardio = Completed. Phew.

It was so great to spend time at home over Christmas break — my sister’s cat, however, was less than impressed with my arrival

It felt a bit like a marathon, and having actually raced a few of those, I don’t use the analogy lightly. Six weeks of actual material plus a two week intermission for Christmas break. Well, intermission probably isn’t the right word since I spent an embarrassing amount of those two weeks at home trying to figure out exactly what it was the heart did and how. The cliff notes version of my learning: it pumps blood. And that’s really important.

Yea, okay, I say that a bit tongue-in-cheek, but seeing as it’s still my self proclaimed “be a real person” post-exam weekend, I have zero intention of talking science — even though I have to admit, it is pretty cool science. It’s also pretty cool to be really getting into the nitty gritty of medical school, learning about the organs and systems that allow our remarkable human bodies to do the countless tasks they perform each and everyday.

I think about that a lot, honestly probably a lot more than I should — just the way our bodies are fashioned together with these complex and seemingly disparate units that ultimately rely on each other in order to do, well, practically anything. The more pathology I learn about ways things could and do go wrong, the more I realize how impressive a feat is to be alive and functional for any human being. In my world, and considering the size of that injury causing dead tree, I consider it nothing short of a miracle.

Beyond learning about the physiology and pathology that make up the organ system our module is devoted to, there’s a clinical component where we delve into the real world of patient examination and diagnosis. Now I’ve worked with patients quite a few times since starting med school. For example, there have been patient interviews in the hospital, I attend a clinic every other week where I work with an attending physician, and I also have sessions with standardized patients in the CEC (Continuing Education Center).

Heart of the Matter

Since returning back to school from a nice 4-day break over Thanksgiving, things have sure taken off. I know I know, I start a post off talking about Thanksgiving and Christmas is barely over a week away. What can I say, some things just find themselves being placed on the back burner (and to be honest, I should probably be studying instead of writing — oh well, I’ll get back to the books at some point tonight). But anyway, back to the “things have taken off” comment…

Med school is always “busy.” There’s a lot to learn (cue the “med school is like trying to drink from a fire hose” analogy), lots of activities/clinics to potentially get involved in, and of course you still have to attempt to be an adult and go grocery shopping, wash your underwear, and (kind of) clean your apartment. But I don’t know, things feel like they’ve picked up since Thanksgiving and I have a hypothesis as to why.

We started organ systems.

What does that mean? Well, it means I’m learning things that have extremely obvious clinical implications. It means I’m hearing lectures where the vast majority of the information being presented would never have been covered in an undergraduate course. It means my weekly schedule is filled with more in-person and online lectures (all covering different and extremely important material) than it has been in the 4 months of med school prior. Now don’t get me wrong, it’s such an honor and privilege to have this opportunity to learn these things and be here — it just seems like organ system modules progress at a different pace that is going to take a bit of time to adjust to.

Studying with the 4-legged one

Our first organ system — cardiovascular.

It’s a bit comical, every doctor seems to make sure to point out how their field is the most important and the organ you’re going to learn about is the end all be all to well, life. The pulmonologist points out you need lungs to breathe. The neurologist says you need innervation of the lungs by nerves for them to even work. Then of course, the cardiologist takes no time to remark that without the heart, you wouldn’t have a reason to worry about any of the other organs. Of course the reality is that the body is a system of organs, but human pride seems to like rankings.

It’s been an exciting (if not overwhelming) two weeks, although I’ll be the first to admit I doubt you’re currently reading the words of a budding cardiologist. At the same time, you wouldn’t believe how remarkable the heart is. The insanely artistic way it’s formed, starting as a long tube in a 24 day old embryo and becoming this complex, beating, 4-chambered power house of circulation and muscle 8 short weeks later. 

To blend? Or not to blend?

I’ve never really been known for my ability to blend.

Not Blending — with Filmore the sheep

Maybe I should just blame it on my genetics and the fact I easily stood a good foot above most of my classmates for the majority of my childhood years. After all, when your “person” is composed predominantly of legs and your haircut isn’t exactly subtle, well, you’re kind of asking for it. I guess I should also mention I’m a middle child and I definitely grew up with that “middle child syndrome.” What does that mean? Well, I was plenty loud (read: obnoxious), basically all the time, to ensure I wasn’t forgotten about. And I sure wasn’t.

Yet, funny story; looking back, I could and did “blend” on occasion. I guess it was more of a when-it-suited-me kind of situation. Those days in class where you really didn’t want to be called on so you sat in the middle of the classroom, avoiding the extremes of front or back in order to best meld with the crowd. Or how about those times you’re at the grocery store to pick up those pseudo embarrassing personal hygiene products or some new underwear (even though everyone uses them) and you slowly meander to the aisle, keeping a casual pace so as not to draw attention to yourself. Or when you’re waiting for your delicious warm beverage to be made at Starbucks, you take a step back in order to 1) be out of the way and 2) to observe your surroundings as a non-participant.

It can be nice to blend.

Comically, I mentioned being 6 feet tall was one of the reasons I didn’t typically blend as a kid/high schooler/undergraduate student. Let me tell ya, cutting it down to 4.5 feet sure doesn’t help either — somebody add a point to my “extremes are bad for blending” theory. Naturally, I don’t think my struggles blending now are strictly due to that foot and a half height difference. Even though there’s a pretty high prevalence of Americans who self-identify as being disabled, you don’t see very many wheelers (especially young ones) rollin around the city of Chicago. So I get it, I don’t really blend. I think the hard part of that comes from my more recent realization that I really can NEVER blend.

Yea, I know it’s a bit sad that it’s taken me 4+ years to truly recognize that no matter how much I want to look like or be like everyone else, I never will.

“But Sam, why would you want to be like everyone else?! Differences and being unique is what makes the world diverse and awesome!”

True. But the ability to blend in is an ability that should be more appreciated than it is.
Or at least that’s what I thought since starting med school until last week.