Blepharospasm

Less than 12 hours from now, I will be taking yet another set of examinations. As usually, I am not concerned about the first, which focuses on diseases covered during small group discussions, but I am concerned about the second. The second exam tomorrow is another customized NBME exam. Though, I did well on the first customized NBME, I'm worried that the faculty "went easy" on us since it was the first one.

My gut is telling me that the faculty is going to go to the opposite extreme this time -- that they've selected the toughest questions from the available pool. My gut's telling me that I don't know the material well enough to execute another knock out performance. Then again, my lactose intolerant gut may just be cursing me for that scoop of chocolate chip cookie dough ice cream I just ate.

Why did I do that? Why??

But, I know I'm really stressed about this exam because my eyelids keep twitching. That's right, my left upper lid and, sometimes, my right lower lid have lost their mind. It's the most annoying thing I've ever experienced. Every now and then, I have to stop reading because the twitching is so out of control!

I decided to look further into this eye twitching, so I looked up "eyelid twitch" on the trusty MedlinePlus Medical Encyclopedia and discovered a great new medical term: blepharospasm. Blepharospasm is the repeated, rhythmic contraction of the eyelid muscles. It's most commonly caused by fatigue, stress and caffeine. Check, check, and check.

Apparently, it can get to the point where the eyelids actually close and then re-open, i.e., you blink. Let's hope it doesn't get to that point. I don't want the professors, or fellow classmates, thinking that I'm winking at them. Though, now I have a good excuse for when I'm in one of Dr. F's lectures. "No, I'm not winking at you. I have blepharospasm."

Recognition

Everyone enjoys having their hard work acknowledged. It boosts morale. That's why I think an honor and awards ceremony, like the one held by my school this week, is so important.

As medical students, we live crazy, often unhealthy, lives. It's a life full of sacrifices and one that you have to go through to truly understand and appreciate. With all the time spent in lecture and lab and small group discussions, not to mention the countless hours spent studying, it's easy to lose sight of where you're going. After listening to two distinguished speakers who have been where I am now, however, I feel reinvigorated. I can once again see where my hard work could lead if I just keep at it.

Although the ceremony ran long, as these types of events tend to do, I was pleasantly surprised by how inspirational it was. My class all but swept the awards. Watching the top 5 or so students in the 2nd, 3rd, and 4th years go up for their awards made me want to work harder so that I too could receive one of the big awards (cash prizes are nice, y'all) before I graduate. I guess it was the spark I needed to get my competitive side burning again.

Being surrounded by these amazing physicians and future physicians me realize how much I can and already have accomplished. After all, we made it to medical school and are still here. (And, I was presented with an award (sans cash, but nice plaque) in recognition of my work over the summer. ) As one of the presenters said, "You all get so blinded by the workload and exams and sleepless nights that you can't see how high you're already flying."

Pain

Anyone else out there suffer from chronic pain? Or experience pain on a fairly regular basis?

For well over three months now, I have been been living with pain in my hip and lower back. At first, it was just a mild pain. I was aware of it, but it didn't really bother me much. Kinda like a loud neighbor watching WWE at 1am on a weeknight. He's obnoxious, but not so annoying to make you go next door to ask him to keep it down. Lately, however, the pain has become more of a moderate pain with episodes of severe pain.

Shortly after one of my most recent exams, I made an appointment at the student clinic to see if they could tell me what was wrong. Of course, I'm thinking I have chondrosarcoma or some other ridiculous differential. After taking the history and performing the physical examination, the physician believes otherwise (shocking, I know) and sends me home with prescriptions for an anti-inflammatory and a muscle relaxant.

While I did experience some pain relief after taking the drugs, I had to stop taking them after the third day. Why? Because I kept waking up in a poodle* of drool, face down in my book, page stuck to my cheek. These drugs made me so drowsy, I couldn't get any studying done. So, they had to go. I can deal with the pain.

I blame the pain on medical school. Going through first year, you think you have it rough, but then you get to second year and realize first year was like water-skiing on glass. There seems to be no time to do anything else but study this year. I tried to stick to a healthy diet and exercise plan, but that didn't last long. I wake up, go to school and sit through lectures. Lectures end, I go home or to the library and sit and study. I go to bed, sleep in the fetal position (or at least I fall asleep that way) and my body has been in the same basic position all day. I need to recommit to exercising and eating well because I can't let my health deteriorate.

Also, I think I finally understand the wheeled backpacks. I know, scary! But, I'm just one muscle spasm away from buying one. I'll make it look good, though. I know I will.

* Just noticed that I wrote "poodle" instead of "puddle." LOL

Dr. F

Fetching. There isn't another professor that captures more interest than Dr. F. When he's scheduled to lecture, we all show up to listen. . . and stare.

Everyone's had their own private love affair with Dr. F at some point during the first year and a half of medical school. For some of us, that love affair has never ended. I mean, the man commands attention by simply walking into a room. For starters, the man is Fine: tall, handsome face, great smile, and fit. No one makes a long white coat look better. (Yet.)

Once you get past Dr. F's mesmerizing beauty, you realize that there's substance to match. There is just something special about someone who can engage you in a subject and lead you through a concept in a clear, logical manner. His lectures and PowerPoint presentations match or, dare I say, exceed those of Dr. A, oftentimes clarifying concepts taught poorly by other professors. He is the king of physical diagnosis, providing us with tips on how to discriminate between, say, ehrlichiosis and RMSF. And, he holds comprehensive reviews to make sure we are retaining the information he presents.

Essentially, Dr. F is our dream instructor. Our very own McDreamy, if you will.

Dating II

Now that fall has firmly established itself and the temperatures are consistently low, my classmates are quickly pairing up like tubulin subunits. (Wow. Did I just write that? Well, can't stop now.) I think that classmates are looking for that special someone to snuggle up with during these cold fall and winter nights. You can see these alpha-beta dimers all lined up in a row in the center of the lecture hall -- a microtubule of sorts, lectures and whispers being passed from one end of the row to the other.

It seems these intra-class daters have formed their own little club, some of them even vacationing together this upcoming holiday weekend. They are having fun together, and I wish I could join in the fun.

Dating within the class is working for a healthy number of classmates. The more I think about it, the more sense it seems to make: (1) you have the same examination schedule, (2) you understand the pressures, stresses, etc., (3) you can spend a lot of time together, even if it's spent in class and/or studying.

But what if things go wrong? That question always comes up, right?

Well, I don't know. However, class attendance has dropped precipitously, with attendance being high only for Dr. A-type professors. Therefore, if things don't work out for our intra-class daters, chances are they'll only see each other on exam days and maybe the occasional lecture. Furthermore, now that one of our exams each unit is a customized NBME exam, you really can teach yourself by reading Robbins, studying board review books, and doing practice questions through prep sites such as USMLE World.

I want to be paired up too, but I think there's a mutation at one of my dimer binding sites.

Hypochondriasis

When I started medical school, I told myself that I wouldn't become one of those silly medical students who believes they have every recently learned disease. HA! Who was I kidding?

As we go through the organ systems, there are moments when I'm convinced that I have at least one or two of the diseases mentioned. OK, maybe four or five.

Gee, my hip has really been hurting. I think I have chondrosarcoma. What? My x-rays show no acute pathology? Are you sure?

Gee, I seem to have some discoloration in my skin. . . acanthosis nigricans? Could it be paraneoplastic (yes, it's always cancer)?

And now that I have my stethoscope. . .

Hmm, is that an S3 gallop? No, definitely S4. Maybe I have hypertrophic cardiomyopathy? See, not having enough time to run is a good thing after all .

Hmm, did I just hear crackles? Pneumonia-- no, interstitial lung disease-- no, pneumonia.

Fall

Just as the trees (the deciduous ones, at least) stand naked in the fall after losing their leaves, I feel that I stand bare and exposed when the temperatures drop and the nights grow longer. I don't smile as much. I don't laugh as much. I sleep way too much (that's 7-8 hours for a med student).

Though I love fall weather and fashion (who doesn't love layers?), fall also hails the beginning of what feels like a barrage of holidays. And not just any holidays, but the most hyped holidays of the year -- holidays that you're supposed to spend with your family: Thanksgiving, Christmas, Hanukkah, Kwanzaa, etc.

My mother died on Thanksgiving eight years ago. She was the only family, flesh and blood, that I knew. Every year, the holidays just seem to remind me of how lonely I feel without her. Pair that with the isolating nature of medical school life, and it's obvious why I feel so alone during this time of year. At the core, I'm still just a child that misses their mommy.

In addition to the holidays, the material that I'm currently studying is a reminder of my mother's death. I read about and study the pathophysiology of congestive heart failure and pulmonary hypertension, I hear "cor pulmonale" and "dyspnea" and "ventricular fibrillation," and I can't help but think back to how my mother had to sleep propped up by pillows (orthopnea) and how swollen (edema) she looked the last months of her life. There's just no escaping it.

Today is All Souls' Day, so at church this morning I was again reminded of my loss. However, I was also reminded that I'm not alone in my grieving. We all experience loss during our lifetime -- it's part of being human. It was a comforting reminder.

I'm sure there are others in my class who have experienced the loss of a loved one, and it's probably just as hard for them to learn and, in a way, live through the disease or process that took their loved ones life. In fact, I'm sure there are many medical students and medical professionals who have to deal with a similar situation.

We are not alone. I am not alone.