Friday, December 30, 2011

Institutional Responsiveness

Duke has been interesting in that they are constantly concerned with how their students feel about their courses. Beyond the ready availability of the course directors, we are given access to anonymous student surveys on a regular basis where we rate our professors on many key areas and have the option to write additional comments. And things actually change based on student feedback, which is good to know.

I was really impressed by the responsiveness of the instructors to the students. One of my classmates was really concerned about the timeline for getting grades back for our physiology final and emailed the course director. She had the tests graded and our scores entered online days before we were expecting them (unlike the rest of our exams this one was taken on paper and had a short answer portion so grading was more involved). A med student wanted to put together practice practicals for Gross Anatomy so the course director organized it and arranged for the lab to be staffed during them so if students had questions there was someone to help them. Someone didn't like that a particular microanatomy lab instructor didn't do presentations before diving right into slides, so even though he was a big proponent of active learning (ie: learning by doing/finding stuff yourself) he started giving introductions/additional handouts (still not as involved as some of the other lab instructors but in response to last year's students the powerpoint presentations given by other lab instructors were made available online). I know that there is at least one very vocal opponent to the number of mandatory class sessions in the Body and Disease course we will have in the spring. I'm not sure what the outcome was, but I know that he had a meeting scheduled with key personnel in the school of medicine to discuss it during exam week. It will be interesting to see what comes of it.

It is good to know that students have a voice and that the administration listens.

Tuesday, December 27, 2011

I got Robbins Pathology for Christmas!

Because all of the cool kids ask for pathology textbooks for Christmas! I also got some awesome stuff that will make my life cushier, and I get to get a facial! And my sister got me this, which is hilarious and makes me feel better about all the gross people in the world who don't wash their hands after they use the bathroom (you people know who you are!).

Christmas was good, we spent several days at my parents' house hanging out, eating tasty Filipino foods, playing board games, and sitting around talking to each other. We had our actual celebration on Christmas Eve, so we were able to head back to NC on Sunday. It has been the laziest week ever and I can't believe it is only Tuesday! I might even be completely caught up on sleep :) I still have to sort through the piles of laundry but other than that all that we have to do is ensure the dog gets walked and everyone gets fed. My husband is on vacation this week so he is here along with the dog. It is great to be together as a whole family for a while.

I have to swing by campus tomorrow since my laptop has a virus of some sort. I need to print a few things and check to see if the IT folks are there even though the school of medicine is on break. It would be fantastic if they are there, but I'm not going to get my hopes up! Luckily my dad is in SC with my mom until classes start up again so I stole his laptop for the week. I counted and it turns out we have five computers for two adults and two kids right now, which seems a little ridiculous. I could probably survive the six days between now and the start of intersession without my computer if I had to.

I'm excited about classes starting up again. It will be a completely different experience without the med students and getting to do the rotations. I can't wait to see what it will be like!

Wednesday, December 21, 2011

People I liked working with

Our final grades posted this morning and we got the official email announcing that we all passed the Normal Body unit. Our professors did a really good job of getting everything graded and posted quickly. Being officially done will make it easier to relax over break! Maybe now my dreams will stop tracing the flow of blood through the head.

January will be a fun month, we're splitting into two groups of four and will be alternating days on surgical pathology and autopsy pathology in addition to our lectures. It will be our first time working with the Duke PAs. I'm excited! This is what I've been waiting for since we started! I like grossing so much and I will get to do it again, hooray!

A couple of the people in the program have stayed employed where they worked before they started school and pick up a few hours over breaks but I didn't. It makes going back to where I worked before a sort of hazy area HIPAA compliance-wise. Especially since the grossing folks work nights and the supervisors aren't around to get permission from. I don't want to get anyone in trouble. Next time I'm remotely in town I will have to try to take everyone for mexican food or something. I worked with great people I really like, which is a plus in any job but especially important in something like grossing.

Where I worked there were three of us and the work was shared, which means that you had to be able to count on the people you worked with. If someone was out for whatever reason (illness or vacation) it meant the other two picked up the slack since there was no one else available to help. The gross room had the fewest sick days of any department in the company, not because we were particularly healthy but because anyone calling in was aware of how it affected the other two. And it was good to know that if you were one of the two people there doing the work of three that the other person working that day had your back. That they were willing to stay as late as you were to make sure everything got done that night that needed to be done, even if it meant working hours after our scheduled time off, shifting our schedule for the entire week, literally running to the bathroom when we couldn't take it anymore, and eating dinner as bites snatched standing up in the warehouse while a courier unloaded the next group of specimens. They were great people to work with and I hope I am even half as lucky when it comes to who I'll be working with after I graduate.

Some of our second years have already started job hunting (and at least one that I know of already had a job lined up for after graduation!!) and it is interesting to see the dynamics in a field like this where the demand is greater than the supply. As a grossing tech I was well compensated and had a fair amount of autonomy and trust where I was working, but if I were to change jobs? I would probably have taken a big pay cut and been limited to doing smalls. As a certified pathologists' assistant, the prospects are significantly better so students can be selective about location and work environment. As first years we are definitely paying attention to how the job hunt goes for the students who will be graduating next summer, and so far it is nothing but good news. :)

Tuesday, December 20, 2011

And still... the anxiety.

I spent a few days away from any place I could accurately call home. I was a guest, a halfhearted tourist in the mountains. I slept embarrassingly late, responsible for no one else. I took every meal in restaurants and started reading a book from which I will learn nothing.

I drove home late last night, coming down out of the mountains down dark deserted stretches of highway with nothing to see but my headlights bouncing back to me from the reflectors lining the road. I played my favorite album, the one I know all the words to without having to think about it. I drove through the night and into the small hours of morning singing and stewing.

I came back to the house where my husband still lives several hours after he went to sleep, but my dog was there to greet me. It was an unsettlingly familiar experience echoing every night I would arrive home from working second shift to a quiet house. Except everything is just a bit different now. The rooms echo stripped of furniture and everything smells faintly of new paint and drywall supplies rather than something simmering in the kitchen. I do not live here anymore.

It would be inaccurate to say that I'm not feeling just a bit sorry for myself at present. I don't want this blog to focus so strongly on me and my test anxiety because for other students reading this to see what PA school is like it will have no relevancy for them (or at least one would hope). But it is a definite part of my higher education experience.  It would be the miserable part, the only one. Even the long nights studying on campus or cloistered in my study room in my apartment isn't unpleasant since it feels fueled with a sense of purpose.

Railing against the universe wouldn't do much good here. Test anxiety was a part of my life well over a decade ago, I got treatment, I took many classes after it where it wasn't an issue, did quite well at rather important standardized tests, and thought it was all in the past. It was an extremely unpleasant surprise to find out that it was not. However, the fact is that being mad or sulking or collapsing into ball of self pity isn't going to make it go away.

So I told my husband about it because I know from the past that keeping it to myself without seeking help just allowed it to do more damage. I told my course director. I went for counseling and got a prescription to help alleviate the symptoms, which I had for the last three tests of the month of tests we had in October. And it helped. It wasn't magic but it removed me far enough from the anxiety to be able to function. I could still feel it but it didn't take over. The last week of exams was difficult, the anxiety built over the course of the days leading up to the first exam and continued to climb through the end of the week. I almost threw up on a cadaver during the final anatomy practical but I was able to eventually finish it.

I don't want to let the memory of the experience destroy the holiday break. I will go back and talk to the psychiatrist and reevaluate the treatment options I have. Therapy has been less helpful for me since I don't, in regular life, have anxiety, depression or much in the way of complaints. It is just the three hours or so of a given exam out of hundreds of other perfectly nice hours that are the problem. I have an elevated response to a normal and expected stress. It will be dealt with and life will move on.
Now I'm going to go spend time with my dog and start wrapping presents.

Friday, December 16, 2011

Christmas break!

My more typical notes
Exams have all been taken. After a week of them I feel completely wrung out. A week of exams, weeks of long days studying, stress, complete neglect of folding laundry (it is clean, just not folded but still taking over my room) and other non-essential life chores, etc and it is now Christmas break.

My youngest
I'm going to a friend's wedding tomorrow (but have to get something to wear to it and need to get a gift bag for the present I finally remembered to order on Monday), followed by a quick trip to see my best friend's new place in Asheville (I say new but it has been six months!), then to my old house until Christmas to spend time with my husband and my dog. It will be strange to go to where I used to live since we don't have any real furniture anymore but awesome to spend time with them. My mom is stealing my kids for a week since she hasn't seen them since September sometime and she has gone into withdrawal.

After Christmas we're all coming back here to re-organize the apartment and give everything a good de-cluttering. I think we'll finally be able to put up the kid's summer clothes. It should be a calm week, hopefully. Quiet and calm and tidy.

I look tired because I am
Did not have a good time with test anxiety during the gross anatomy final, I will have to wait and see what the impact was on my grade. I will have to discuss things with the doctor to see what can be done for the future. The spring with Body and Disease will have more TBL based learning/testing, which should help.

January will have surgical and autopsy rotations and neuroanatomy. I can't wait for that. And we received our schedules for Body and Disease earlier this week so that's something else to look forward to. A long stretch of pathology and microbiology, hooray microbiology! It was my undergraduate major and I love it. Who has two thumbs and is good at streaking for isolation? This girl! You want to know what agar to use to isolate and identify S. aureus? I know that! 

The book store was having a sale and had something in stock they have been out of for a while, so I bought myself a present. Hence the pictures. And why everyone in my family is getting Duke gear in their stockings. 

Wednesday, December 14, 2011

The fear of the fear.

I am going to assume that this week's anxiety is due to the back to back to back nature of the final exam schedule. Either that or I'm just a crazy person. I really hope it is the former and not the latter. I had a pretty good stretch there in October where we had tests every Monday, at least after the first Monday which was before I started anti-anxiety medication.

Sadly it isn't a magic pill that keeps all anxiety away. It does make things duller though, which helps. I think the fear of the fear is the thing that is the worst. The anticipation of having a reaction I don't have much control over.

But it could be worse.

Monday, December 12, 2011


I can't help but worry--as I study--about my anxiety. After the kids were in bed Saturday night I took a break for two hours to watch a movie with my husband, and the whole time I kept wondering how impacted I would be during the test. It seeps into my dreams.

Dullest manifesto ever
I wrote out notes, pages and pages of handwritten notes on 11 x 14 inch paper. My husband said they looked like a crazy person's manifesto. I re-watched lectures, I consolidated the notes group notes into handy references for each lecture. I read the instructor's notes that turned a 50 minute lecture into a 19 page document. And the entire time I'm doing this and studying and learning and relearning I'm completely cognizant of the fact that none of it may end up mattering because of the anxiety*.

The medication helps, it helps a lot, but things still come through. One of the instructors came into our room after the test started and wanted to look at my exam (the PAs have paper exams). My first thought was, OMG, he's looking at how wrong I am. My second thought was, what did I do? Did I do something wrong? I'd only answered a few questions by that point. He said he was just checking because another student seemed to be missing a question (I think it is more that one of the questions was at the bottom of a page and the table with the answer was on another page, we had a couple questions like that). Still, it was unsettling.

Even with that today wasn't horrible. My reaction was pretty normal, I think. There were things that didn't dawn on me that I knew until after I turned the test in but it felt like normal human fallacy and not the elevated, escalated mind going completely blank reaction of a panic attack.

No one really feels good about today. Favorite status from FB from a med student: On the bright side, I learned today that on a multiple choice exam, having no idea what's the right answer means click randomly and then leave early.

I miss working. I've never felt any anxiety with that in the slightest. I only get it with tests and not even every test. It would ironically be easier if this program mattered to me less.

*Alternately because the questions asked will inevitably not be the stuff I studied. Which, from the comments after today's test, seems to have been the case for everyone.

Thursday, December 8, 2011

Studying for exams has eclipsed the rest of life

I haven't seen my kids in any meaningful way since Tuesday some time (and even then I was home but studying, so I'm not even sure that counts). I studied last night and tonight in the PA room until 9:15ish, which is well past their bedtime. I'm going home right after gross anatomy tomorrow and will stay home to study this weekend, so I'll see them off and on. I'll be holed up in my studying room in the apartment but I like to come out from time to time for hug breaks. My kids like hugging.

My dad has been in charge of feeding and tending the kids. He doesn't seem to be going crazy and they're still alive so that's a good sign.

Meanwhile, I'm so tired of studying but that's fine. It is only for another eight days, then it is a fabulous two and a half week break followed by January intersession. I'm so excited about January! We start with autopsy and surgical pathology rotations. But first I have to survive exams.

Everyone has to survive exams first. Med students are posting all over facebook with predictions of gloom and doom. Cumulative exams are horrific since after a couple months all you retain are concepts, not the level of detail you need for tests. There are a lot more lectures to study for this test.

I will write a real blog entry after exams.

Monday, December 5, 2011

My day was cooler than yours

I don't want to come off as weird or morbid or gruesome, but I had the coolest day ever today at school. I got to cut our cadaver's head off! It was amazing. It just isn't one of those things that happens very often and I'm glad that I got to do it. Would I want to do it a lot? No, probably not, but it was still really cool to get to do it once (The dens is really hard to cut through, by the way.). I got to stick my finger through the foramen magnum while we were checking our position and it was just so neat to trace the path of the spinal accessory nerves, the spinal arteries, etc. It is not an experience that most people will ever get to have and I feel lucky to have done it. I will never again have the opportunity to dissect a body so thoroughly. And for everyone who didn't come to gross anatomy (I'll talk about this in a separate blog entry) they missed out on that. It is completely their loss because that has been the best gross anatomy lab so far.

Quick, name all the structures!
This week is strange. We're not having a lot more new information presented but we're having clinical case information given to us and by taking patient history we're supposed to be able to go through the differential diagnosis process to decide what to test them for. They are mandatory for med students (well, mandatory-ish, since they aren't taking attendance) but optionally mandatory for us. The one today did go over some of the material and we will probably remember that course material better than the things we didn't have in symposium, but for the time it took it wasn't high yield study time. Oh, and when you ask a bunch of PA students what tests to run on someone with abnormal uterine bleeding you get answers like "Let's do an endometrial biopsy!" in addition to the blood tests you're probably after.

It looks to be a fairly light week, which is good because everybody is in a state of semi-panic over the upcoming exams. It is a terrifying amount of information to be tested on in just one week. It should be doable. I keep telling myself that it is doable. I am hopeful, oh so hopeful... and yet so very scared at the same time. I spent this past weekend studying, I'll study tonight after I finish writing this, I'll study for two hours tomorrow morning before class starts, an hour over lunch, and all tomorrow night.

My kids started basketball week, but my dad is taking my oldest for practice tomorrow and my husband and my dad will take both kids to their separate practices on Saturday. I'm still trying to decide if I'm going to study on campus or holed up in my study room with headphones in at home.