Holidays

Shortly after Thanksgiving, I texted that girly to ask about life. This is the girly with whom I had prayed about dating, and then she essentially made it clear that I should not try to communicate with her. But it had been six months and I do not like to hold grudges or stay angry (she had responded to things in a notably unempathetic manner), so I opened with an apology. We texted as comfortably as if nothing amiss had happened, and we made plans to meet for coffee when I visited home the weekend before Christmas. She was very excited to see me, and I was trying to get over my angries through casual friendly exposure, which was fairly effective. I insisted that we celebrate her birthday early since I would not be in town for it, and she obliged.

Family was fun over that weekend. I was on call on Christmas Eve, so I had to drive back to Houston, but I was secretly relieved, because I sang karaoke two nights in a row, and also had to manage a little family drama, which seems to be the norm these days. Christmas Day, I Skyped with family and then went to dinner with some fellow medical students.

On New Years Day, I will be one month away from completing my third year of medical school rotations. This means that I will begin studying for the second hardest exam of my life (I already passed the hardest one). It also means that I am potentially a year (or less) away from becoming a doctor, and about a year away from booking tickets to Southeast Asia to go backpacking before residency. I hope that friends join me. At least three good friends seem a lot more interested. It looks like I have already saved up close to enough for the trip, depending on whether I find a good flight deal.

It has been difficult to make myself study much at all during this rotation. Once I watched all the surgery lectures and read up on some anatomy, there was not much pressure to study more, because most of the learning curve has been practical. I simply had to learn to scrub in and assist a little in surgery, but not much more than that. But I need to study consistently and well in order to get a good enough score for residencies to want me. Ugh.

Perking Up

Over that break, especially over Thanksgiving weekend, I felt off within myself. Being good friends with people who have drifted so far from what you are is an odd experience. And it does not help that I feel as if I have drifted some from who I am, or at least that that persona is only loosely fitting, like I have shrunk down a size. Time continues to pass and I continue to be shackled to my clearly paved pursuit of becoming the best human I can be. Friends get married, have children, or decide that they do not believe in either, or whatever else, and I am just attempting to keep the subclinical depression at bay as the vacationless academically saturated future looms. Resident friends emphatically tell me that they are very ready to be done with it, to finally be living life and making money. I too feel ready for this, yet I will not be at that point for several years.

Anyway, as depressed as all of that sounds, I am actually perking up at the idea of some creative pursuits arising. I may be unable to travel, but I can write. And I may be unable to edit much, but I can record videos. It is better to have some footage rather than none, some memory of this rather than a blur of sadness with bursts of pleasantries.

Either Or

My sister's dog was injured tonight. As the medically trained person present, I was asked to assess the dog, and the swollen left shoulder was enough for me to recommend taking it to a vet. It turned out that she (the dog) has a broken shoulder, collapsed lung, and some other life-threatening internal damage that would require surgery.

Unfortunately, one of the veterinarian offices that was googled was the one at which my one-time crush works. What was once a pleasant memory has now become a thing to avoid. She has started to appear in my dreams sometimes. It is always a casual thing. I see her at a bar or something, and I immediately brush over things. After all, it would be dumb to bring up any of the issues in the letters I wrote but never sent when I had become frustrated with her. Speaking of which, those are still in my car in sealed envelopes that I should throw away. Yes, at once point, I must have thought that expressing myself in whole would be a wise idea. There is a reason why I have not dated; I am too intense. Apparently.

I thought of texting her about the dog. But then I would break my childish agreement to not be the one to text her first. I stopped texting her the funny tweets and things of that nature because it truly does take time for me to discover those, and, well, she kind of hurt me, however unintentionally. The problem is that I never got the chance to know her well enough to assume the absolute best in her, so her accidental cruelty cannot be excused quite so casually as can, say, the dear friend who (technically) sexually assaulted me.

I am currently filled with whiskey and I can say with some surety that I would not want to fully feel the potential feelings that may be present now. As much as I was taught to abhor it, and as much harm as it does to the body on so many levels, alcohol helps me to tolerate being alive. I hope to replace it with people, which is a major reason why I wish to move back to Arkansas, where dear friends reside.

I wrote a poem today about the devasation wreaked when someone like me likes a girl. It. Is. Dumb. The highs were high but th elows that follow are so, so very low. And the worst part is probably that I consider her to be such a worse person.Every human should be overestimated in the highest regard, yet here I am disliking an intelligent and beautiful woman simply because we flirted with the idea of being together.

Anyway, I hope that these issues resolve somehow. Or that I just die soon. Either,  or, I guess.

Squiggly Line

Awhile ago, a friend who is still in his first few years of marriage told me something that I had not considered before. He said that being married does not stop you from feeling lonely. I had never considered the possibility of a life without the loneliness, but that is partially because I have not considered a long-term romantic relationship to be a realistic possibility in the near future. But the time is likely to come, at some point, when I will let myself think in those terms. And with the wisdom of my friend in mind, I need to keep expectations relatively low, realizing that those last feelings that crawl into my mind late at night, those ones that remind me of how vastly bereft I am of companionship in this world, those feelings will remain no matter what changes I undergo in life.

There were many times in the past when I was so close to God that those thoughts did not besiege me, but that was also before the mid-20's subclinical depression set in. It was when I knew considerably less about life and faith and the nature of things. It was when I leaned heavily into my creative side rather than my scientific side. When the creative side dominated, I kept myself in a careful balance. As soon as I had any sort of personal or spiritual issue, I would take care of it. My friends would tell me of their struggles, and I could never relate, because when I found a problem, I generally solved it within myself by the end of the day.

Unlike in the past, however, I retain problems. I sometimes recognize weaknesses and allow them to coexist with my strengths, rather than eradicating those faults. This began partly as an attempt to relate to every human, but also as a result of becoming a better academic. The mental shift to deal with emotional or spiritual difficulties rather than focusing on the present work to be done frequently felt too great to properly address while still maintaining discipline with my studies. In a similar vein, the further I have progressed into medicine, the more I have treated my spiritual or emotional difficulties as illnesses to be dealt with quickly and efficiently so that they do not distract me overmuch.

Thus do I have this struggle. The best, happiest, most fulfilled version of me is the missionary. But that version of me requires maintenance that I have not consistently been willing to manage. And frankly, I do not know if I can go back to my previous management techniques while still being as proficient an academic as I am (and let us recall that I am not exactly an exemplary student as it is). I feel both sides of me beckoning with their own allures, and I feel as if I need them both to some degree, but to do both would require walking this squiggly line that I do not feel capable of ambulating, not without something giving way.

A Well-Adjusted Person

So I have both this week and next week (Thanksgiving week) off from my clinical rotations. This means that I can let myself think and write and listen to music. What an oddity.

I finally tweeted (with my alternate account) about the (technically) sexual assault. It came about as I was finding myself quite sober last night as I read through past Juice Journals. It is sad to reflect on the changes in friends and myself. My faith was previously my whole thing, and though God still remains the drive behind everything, I have spent so much more time outside of the church since then that it often feels more like an implied thing. The fortunate thing for me, the continuous pull toward that faith, is that I know that the most fulfilled version of myself is the one I find on mission trips.

Though that perspective feels selfish at times, well, it seems like a pretty tame selfishness to possess. When I told a close friend from high school about the sexual assault trauma and processing the other day, he commented that I seem like "a really well-adjusted person". And honestly, any truth to that statement likely comes from this forward perspective of mine, this knowledge that the life around me is a temporary thing, that I am training for something greater. And I do not mean that in a boastful way, just in the sense that I need to be strong and wise and emotionally baggage-free and spiritually sound enough to keep it together when the unpredictable happens and I am the only one with the training to make the difference.

That perspective has kept me from casual dating. How could I go out with someone if I was unsure whether they could handle the life I hope to live? Even if they can handle the baggage-free spiritual side and the talents involved in outgoing missionary work, I also have the other social side, which involves drinking and being comfortable with people who partake in various recreational drugs, or are part of the LGBTQ community, or belong to another religion such as Islam. It is hard to find someone else who is as versatile as that while still holding onto their faith. It is a constant difficulty to walk this line of belief and acceptance of everyone, in part because you face the decision of whether to challenge your own beliefs in order to incorporate theirs, or to have in the back of your mind the sad conclusion that they may not join you when you go to heaven. And at that point, you stray dangerously close to the point of judging. And since "judge not" was a command, that ironically means that you are sinning, even if your original line of thinking was intended to keep yourself properly aligned in order to avoid such a thing.

So that is the mindset that keeps me from a the multitude of these life experiences into which so many others seem intent on blindly leaping. I am aware that I miss out on a lot, but I also retain all of my friends and my generally optimistic view of people around me. When you have an ex, your opinion of them declines greatly, even if you thought the world of them up until the end. You weigh their words differently than you would the words of a close friend, and if the words seem wrong or hurtful, you allow them to have a far more personal impact because you have gifted that person with the privilege of knowing you more intimately.

In the slightly more professional realm of topics, I keep meaning to write about patient encounters and interactions with staff and physicians, but the inspiration just tends to sap out of you at the end of the day.

Free For Awhile

Despite how foolishly I scheduled both family and internal medicine shelf exams a week apart, I managed to pass both of them. So now I can visit friends in Arkansas this weekend without that hanging over me. I honestly do not even know how to feel. It is so relieving to be done with my hardest rotations for my third year, to know that I do not have to take another written exam until next year. Instead of being bothered by those stupid things, I can just focus on learning for awhile.

I really miss living life, and it looks as if 2019 could involve a lot of life after I take the Step 2 exam.

What a dream.

Bereft of Dreams

I was surprised to learn that I passed last week's family medicine shelf exam. I am not expecting such nice outcomes tomorrow, but we will see.

This family medicine rotation is incredibly casual. The doctor is old and paid salary, so he moves very slowly and will stop in the middle of a busy time to tell a joke, usually in one of those "my ex-wife" styles. I scheduled my exams for the weekends so that I can take off a couple Fridays (in the name of said exams) this month to get away.

I plan to visit Arkansas next week, then home a couple weeks later for Halloween. My lack of motivation has been most of my company recently, and my thoughts have not been what they should be, so I have been drinking more. I just... I feel as if, at the end of the day, I am bereft of something to dream about in the future. I want to imagine traveling, or getting away.

Dreaming of the next thing has always been a safe place for me. It is a little spot in my mind into which I can retreat to take an occasional mental break. Study breaks can be filled with research, then I can imagine it playing out as I go to sleep. In fact, for all of my talk of loving travel, what I love the most about it is probably dreaming of it. When I get there, I consume it, try to live it, but in some ways I am miserable. That is, when I travel for myself. When I do missionary work, that is fulfilling. For those trips, I am anticipating as someone else plans it, and the excitement is this brilliant thing of knowing that for that span of time, you are doing God's will. You are attempting to make an impression, and ultimately, you dispose of whatever negative opinion you might have formed because it is not about you.

But my near future consists of seeing friends and a concert. Then after I finish these last rotations, I will be studying for the most important exam of my life, one that will decide what specialty I can pursue. There is a chance that I could go to Africa in June, but that is unlikely. The real exciting possibility will be my backpacking trip to Southeast Asia in 2020, but that is just so, so very far away.

Seeking Motivational Inspiration

As I became further frustrated with the occupations of my mind, I decided to try to make myself have a crush on that model friend of mine again. It did rid me of the preoccupancy of thoughts of that disliked one, at least for now, but I still struggle with what to fill my mind with at night. This provides me with an inclination to drink, but that is an unhealthy habit to maintain chronically, so I am obviously looking for alternatives.

Dreaming of travel was once a viable alternative thought process, but I am unfortunately unsure of whether I can reliably plan for travel within the next year. You can fall in love with places without worrying about consequences on either side, emotional or otherwise.

I foolishly scheduled what are likely to be my most difficult exams for the next two Sundays in a row. The train of thought was that it would be a relief to be finished with exams for awhile, especially since I am approaching my last two rotations. Unfortunately, I overestimated my motivation levels leading up to these test dates. My practice scores are notably below passing and I have not finished reviewing said practice tests quickly enough to feel like I am progressing at a realistic pace. So here I sit at Starbucks, realizing that the added busy sounds of the coffee shop do as little for my ability to focus as the thought echo-provoking silence that awaits me at my apartment.

The missionary leaders with whom I have worked in the past are doing a trip to Kenya next year. They would potentially want to use my "new skills" to incorporate a medical aspect to the trip. I will of course have to inform them that I am still very much a student, but could certainly assist a physician if one decided to join us. In any case, that sort of trip, similar to the one that first put faces and places to this calling of mine, would probably help me in stirring up inspiration within me. But money is very much an issue. If all goes as planned, I do not expect to have time to raise funds. In fact, I am unsure as to how I will manage to pay for school, and residency applications, and all of the other expenses that are headed my way within the next year. So maybe it just has to be up to God, which is probably what it actually is anyway.

Dislike

I do not like disliking people. It rarely happens because I tend to assume the best and also empathize. But the thoughts I have toward that girly are specifically of dislike. She changed her relationship status the other day, a few weeks after texting me "Miss you" and I replied with a pretty disingenuous response with similarly kind sentiments. I could probably think better of her except that her method was to blow me off and make it clear that she did not want further communication, that we needed a break. It was difficult for me to discern what there was to break from, especially since we were just friends and she was emphatic on preserving that friendship.

In any case, cutting off communication seemed in her mind to be the way to fix things. For me, communication is actually the preferred method of fixing things, and breaking off communication after one party has been hurtful to the other tends to lead the hurt party to resent the transgressor.

As I said, I do not like feeling this dislike. I decided today to stop sending her funny tweets (one of a group of people who receives them). Hopefully I can simply avoid seeing her, like ever. If I do see her, my forgiving nature will likely take over and I will be able to get over this. But the dislike is a feeling that has remained in my mind, and has been allowed to grow stagnant there.

I prefer to think the world of everyone else, so it really sucks to have someone lower themselves in your eyes. She resented me thinking so highly of her before, so even that aspect factors in to make me feel justified in mentally placing her with a more inferior group.

Ugh, I do not like thinking of people like this at all. It seems to bear no benefit for anyone.

What Matters

I finally worked a full week (well, not Tuesday) in the hospital. It was so good. This is the first time that I have genuinely thought that I could make this my life, my career. Unlike all of the specialty medicine I have previously worked in, this involves everything. This week, we worked on the orthopedics floor, which often meant that every patient was old or sick enough to have had a bad fall and break something. So the broken parts are managed surgically and with physical therapy, but you are also checking on their comorbidities. Some with internal bleeding, others with pneumonia, or leukemia, or something else. So there is always the challenge of bringing to mind everything you know about this wide variety of diseases, and it is just so fulfilling. You get to establish a short-term relationship with a given patient, knowing that you will likely only have a few days with them at most. And with this rotation, the best part is that when I take a patient's history, the doctor is not going to repeat my actions. What I do genuinely matters to an extent.

We also went to happy hour yesterday with some hospital staff and other medical people. I do not know who was covering the bill, but I left with the knowledge that it (and my meal) was free. I also learned through that that there are occasions for which I should most certainly wear my white coat outside of the hospital (up until now, it has mostly attracted beggars asking for money when I have worn it elsewhere).

On Monday, we had a patient die. We saw him for the first time in the late morning, breathing fast, not conscious, with his wife telling us about how wonderful of a person he was. Then, after lunch and more rounds, we went back to pronounce this patient as deceased. I have only seen a few dead bodies in my life. This is the first I have seen that was a patient. Granted, it was not my patient and I did not know them, but there was something there. The doctor told us about checking the pulse, listening to the heart for a full minute, then checking the pupils for nonreactivity (I rechecked the pupils after she did so). The wife claimed that he had been dead for something like 40 minutes, and the fingers on one of his hands was beginning to turn blue. She commented that the other hand must be maintaining its usual color because she had not stopped holding and kissing it for the past hour.

I hope that I remember to take the time to stop in the future, to preserve the memories of these things. My mind is not naturally designed for medicine, so perhaps my perspective could lend something to all of this.

A Week Off

My first week of general internal medicine (as opposed to the GI medicine that the last six weeks was focused on) is going well, primarily due to the fact that we do not have hospital hours this week. This meant that aside from reviewing a few charts at the hospital on Monday, we did not do anything this week.

However, the brief experience I have had in this rotation is already a breath of fresh air. Solving the riddles of what a given patient has, in terms of learning what orders to send for as well as what to treat with, is so nice. Perhaps what makes the biggest difference in this compared to previous rotations is that I already know enough to sound competent; in the rest, I had a world of studying to do that I never completed till the end of the rotation. I feel as if I have already impressed the doctor a little bit with the diagnoses I have come up with (even if none were what the patient actually had).

Anyway, since I had the week off, my mom came down and we decided to stay in Galveston for two nights. Since it has been a fortnight since school started, the place is pretty much dead. So not exactly what one hopes for when one finally has a reason to leave one's apartment, but there are worse things.

Speaking of which, one point my mom was emphatic about as we discussed some psych issues is the value of life. She spoke of how good it is, how it is better to be alive than not. I disagree. Being alive is exhausting, and the amount of even mildly unpleasant times seems to far outweigh the amount of pleasurable times. And I had thought that before I had the experience of breaking down my emotional walls for a period of time. Even when I was constantly surrounded by funny and supportive friends, I still wanted to die at any given time. This is also because the Apostle Paul spoke so well of life after death; it is rough when your passive suicidal ideation is apparently theologically sound.

In other news, girly texted me last week saying "Miss you!" I wanted to reply "Oh. Kay." but decided to be better and returned the sentiment, despite the fact that I do not have any particular desire to see or interact with her (largely in response to her expressing this position of no desire to interact toward me a few months ago). She also responded to something funny I posted on Instagram. Hopefully I can avoid running into her, or, perhaps better yet, rise above my resentment in such a way as to be both kind and honest when I see her.

I take comfort in the fact that the GI doctor I worked with did not meet his wife until residency. That seems to me to be the most practical way. She is a physician's assistant, I think. Of course, I am so annoyingly particular that it is difficult for me to scrounge up hope in the field of romance. But I did learn some lessons from allowing myself to like a girl. For instance, I must never make assumptions regarding their faith; this one turned out to be new to the faith, and unwilling to read her Bible, though she casually read other material frequently. There were also selfish aspects which I thought were playfully charming, but in the long run, would likely be frustrating to me. And of course, she was tied to her mid-level job to an extent that I felt burdened to try and aim rotations and residency toward her in Dallas (a city I do not particularly care for) rather than toward what would be best for me and my future goals as a physician. Oh, and in general, it felt as if most of my part in the potential relationship was reactive. One of the last things she said to me (when we were talking about anything real) was not to worry, because we were good. But I was the one who had a problem with her, not the other way around. She was like my family, only seeming to understand things as they related to her, rather than using empathy.

It is why one prays about dating, and why one asks for more holy men to pray with them, before committing to anything.

The Search And The Journey

Can I be frank? I am just not like other humans. Not like other guys. Sure, I desire companionship and such, but what gets me going more than anything is this idealistic prospect of saving the world. This whole doctor thing is a means to achieve that, in a way, but as I am staring at that light at the end of the tunnel that is my MD, I cannot help but think that this most noble of professions will still fall short. The dastardly corruption of this world is so awful, the willingness to allow suffering so prevalent, that it seems as if any participation on my part would hardly do anything to assuage such grievance.

Back in high school, I wrote a poem about how contentment is something that I avoid. That theme continues to resonate with me. I am so very rarely content with where I am in life, with what I am doing, that I at some points must take pause to wonder if I will ever reach whatever my aspirations may be. I am roughly seven years away from my proposed death date, and my sneaking suspicion is that I will not achieve whatever it is that I aspire toward before that day.

Some people can be happy with the pursuit of happiness. I, unfortunately, am either too stupid or too intelligent to allow that pursuit to dominate any notable facet of my world.

I have had much to drink and my eyes are actually closed as I type this, so hopefully it is all very insightful and brings a body to the point of extreme revelation. Or whatever.

Goodnight. Continue your search and bask in the journey.

What's Here And What's Far Ahead

This rotation has been the most enjoyable. It is the closest thing I have seen thus far to what I hope to be. It also raises questions for me. The doctor is from a small town in Texas and is very sarcastic, as are his staff. He is nearing his mid-40's and is wrestling day to day with the struggles of balancing work and family. He gives more time to patients than any doctor I have seen, but that aspect does not pay anything extra, so he tends to get to work early and stay later than he may please, and in the end, he makes less money because of the quality of his care.

To what degree will I become like that? Will I even have a family to balance against work? Maybe work will become my everything and that will be reality.

Since it is on my mind, and no one reads this anyway, girly I was liking before posted a picture of herself with what appears to be a new significant other. The feelings that rise up unbidden are annoying. She and I would not have worked together (I let her know I liked her before I was aware of how little she knew or desired to independently get to know about God and the Bible). Yet at the same time, a part of me is jealous. I suppose that it is largely due to the fact that when she was emphatic that she wanted to be friends, she was also emphatic that she did not care to see me or hear from me. And that was after cancelling plans, so it felt...severing. But her daddy issues play into a lot of how she deals with people, so I need to bear that in mind now that my brain works. Hopefully the new boy toy will help me to put her out of my mind.

As always, I am enduring life while setting my eyes a year (or two) ahead. Next year, I will take the next biggest exams of my life. And then freedom to some degree. I will, at some point next year, acquire my MD, and then presumably try to find some work that is at least loosely related to that in order to raise money for my trip to Asia in spring 2020. 6-8 weeks trekking through Southeast Asia, since that will be my last to do so before residency begins.

Inspirations From Lamentations

Since last post... well, I finished my OB/GYN rotation the other day. It was relieving to be done.

I met up with a girl for drinks at a brewery after we connected through a dating app. She was pleasant company, but did not seem pleased at the revelation that I am not really looking to date, since dating is more serious for me.

I matched with a girl on tinder who is actually in Colombia. Oddly enough, we have kept up our conversations. She is extremely attractive, but skipped right past when I mentioned God, but I will likely venture toward having a lil' crush on her for now. By the way folks, that is progress. I am once again normalizing to my own brand of normal in which I have distance crushes.

Though I had to deal with those previous issues, I may still have some feelings that I have been suppressing. Maybe I need to let those out tonight, let myself feel before my next rotation starts.

I read the book of Lamentations the other day. It is presumably written by our dear depressed prophetic friend, Jeremiah, and despite its title, it has a more inspiring passage than perhaps any found in the book named after him. This passage is about the fall of Jerusalem, and, in the midst of seeing the desolation of that city, which to many represented something of a metaphor for God's presence, the author found it pertinent to write this.

"I will never forget this awful time, as I grieve over my loss. Yet I still dare to hope when I remember this: The faithful love of the Lord never ends! His mercies never cease. Great is his faithfulness; his mercies begin afresh each morning. I say to myself, 'The Lord is my inheritance; therefore, I will hope in him!' The Lord is good to those who depend on him, to those who search for him. So it is good to wait quietly for salvation from the Lord. And it is good for people to submit at an early age to the yoke of his discipline." Lamentations 3:20-27 NLT.

In the midst of watching his current world crumble, he still specifically decides to hope as he is reminded of God's unfailing love. But another striking aspect to me was that last sentence, where the author says that it is good for people to submit at an early age to the yoke of his discipline. I have often thought that my early submission feels dumb. Life so far has felt like training for a day that will never come.

Since nationalism and Christian culture are so unfortunately politically entwined these days, encouraging words like those above seem to fall short. I seem unable to articulate further... perhaps this is what the exile felt like.

Basic Counseling

I took my OB/GYN shelf exam today. What a relief. I of course do not know whether I passed, but it felt vaguely okay.

There were some thoughts that I was suppressing until I completed that exam because I am of course unable to keep up academically if I have anything major to process. When I told girly about my issues, I had some expectations which I thought were basic. This I think is primarily due to the fact that most of my good friends understand the basics of how to hold a conversation with a person in a fragile state, even if they are lashing out at you. "I am sorry if I made you feel that way. I felt a particular way and that is why I did such and such, but I see how it had that effect on you" and so forth. See, her response when I tried to ease things was "you're playing the blame game". Just a normal human response from someone who does not know how to process other peoples' feelings with empathy. So now I know to not trust her in that regard. I held her in too high of esteem.

Anyway, with that test done, I am set to leisurely begin studying for my next rotation, internal medicine. Odds are in favor of this being my future specialty. I will have two separate preceptors over the course of twelve weeks, so I hope to obtain letters of recommendation from each of them. I am, at long last, feeling myself again, so hopefully whatever inherent charms I have will make themselves known.

Unfortunately, I am not quite done with the previous issues. I still need to confront my friend who, in a difficult time in her life, sexually assaulted me. Confront actually is not the correct term. I just need to let her know my perception of it and its effect on me, and assure her that all is forgiven. Because I do not burn bridges. That would be dumb.

Disliking This And Wondering About Others

I do not look forward to clinic tomorrow. Only half of the week is spent in clinic, but these extended weekends simply do not feel extended enough.

The bright side is that I am learning my preferences. I do not wish to consistently touch genitalia on a daily basis at work. Yes, I know that there are layers of jokes within that statement.

Perhaps neurology is the answer. From what I understood, that involved some riddles in terms of neural pathways, but little in the way of physical human contact. Psychiatry seemed like an easy version of that, and with fewer consequences (patients were often already there against their will). I took an online quiz that said I should go into pediatrics, and though I do brighten up when I get to spend time with kids, I do not think that I would be intellectually stimulated enough by that.

Oncology would be boring in terms of spending so much time with only one patient population (cancerous people), but I really did enjoy learning about it in my first two years. But perhaps my views on death would not prove to be advantageous there, given that those patients will likely be looking for encouragement to stay alive.

My next rotations are the most likely to be my focus, unless I choose a more specific specialty like those mentioned above. Internal medicine, family medicine, or surgery. With surgery, I obviously will not know until I begin. OB/GYN has been scary because the patients are awake and very sensitive to the physician's actions, but in surgery, they are not even awake to feel. Unfortunately, you do not get to know the patients well in that specialty. It seems to me that that would make work feel a lot like work. Oh, and also varicose veins. I do not wish to obtain those.

Symptoms Gone

Depressive symptoms were gone when I awoke on Tuesday (the day after that textual conversation with girly). That day was easy at clinic, largely owing to the doctor being out for surgery for much of the day. The following day, however, was awful. There is another student who has been favored far more than I, largely because he knows how to take and present a good history. I have hardly improved in that area due to the depressive issues. Inability to concentrate is a symptom that I dealt with to a significant degree, and it kept me from studying or improving much. So there were more new patients that day, with more complicated histories, and I did a poor job in my presentations. I also began performing Pap smears that day under the doctor's close supervision, and she became angry with me after we saw one of the patients. Having never previously encountered a vagina, it seems that I am not adequately familiar with the sensitivities of one, and I did a poor job in my approach. In my defense, every procedure in which I have been trained, I have been told step by step how to perform them. In this, I have only watched it done. Until that day, I was actually unsure of whether we would be performing Pap smears at all.

My mom and grandma were in town that day, so I visited them as soon as clinic ended. Then I went back to my apartment to try to calm myself with a beer. As a chaser for the whiskey. I also texted my friend who is a resident, and he gave me some tips on improving my presentation. Specifically, he gave me a template. That is what I needed, but in my depressed state, it had been difficult to do much.

The next day, we had mostly pregnant follow-up patients, which are the easy ones. I did pretty well with history and the doctor was easier on me, and told me "good job" for what I think may have been the first time. Bear in mind that I had heard her say "good job" many times to the other medical student in this rotation. I know that I have been doing poorly, but it is not as if there is a time to say "doctor, the reason I've sucked so bad is because I was having depressive symptoms from some psychological trauma a year and a half ago, but hopefully I'll improve after I deal with it".

Anyway, with those depressive symptoms gone, I was able to do most of my homework for this rotation (patient logs) today, along with watching all of the lectures for both obstetrics and gynecology. Yes, that is correct; this rotation has two separate sets of lectures. Boy howdy.

Not Quite Cured

I texted her about it. It took me 45 minutes of staring at my phone and rephrasing things, but I sent it. We conversed a little. At the end of it, she said that we are good. I feel better, but I do not know that "good" is the term.

Maybe I have to seek therapy. A low dose of an antidepressant is better than a high dose of alcohol. But I can manage the alcohol on my own, and I do not want to seek out the rest.

I was hoping that telling her my problems (with her) would suddenly cure me. I certainly feel improvement, but I am still terrified of clinic tomorrow. I probably need to let ye olde sexual assaulter know what has been going on in order to normalize our friendship a little.

Perhaps I just need to pray to God a little more rather than just being frustrated with Him.

Moods

My mood improved a lot the day after that post. But then I woke up today feeling groggy and confused as to why an alarm was going off. Then one of my first patients today was not pregnant, but rather had an STD, so I forgot to ask about her periods. In OB/GYN, you always ask about the patients' periods. And I just felt so, so awful. The other student is obviously the preferred one, taking better histories and presenting better. His advantage is that he has done an internal medicine rotation, so he has had real training in it.

Logically, I know that I should take note of these shortcomings in order to try to improve, but these overwhelming depression spells have just been hitting so hard that I end up just trying to walk away and breathe whenever I can. My thoughts keep going to that feeling of betrayal of trust when I confided details of sexual assault in that trusted friend, and she subsequently made a display of distrust. I knew that it was on a level that would be wise to just go to a psychologist or something, but why pay for that when you have a good friend? Unfortunately, betting my mental health on a good friend remaining a good friend is now costing me. Like, all she had to do was be a friend. That is all. Instead, she does not wish to see or speak with me.

So I do not know where to go from here. If I try to add breaks between rotations to work on myself, well, I have no friends in the area, so I would just be lonely for a week. Plus, all of my rotations are scheduled for the year. I have thought of seeking professional help with antidepressants, but there are a number of issues with that. For one, I would have to mention that in my future applications. For another, antidepressants do not kick in for weeks. And honestly, I do not want to visit a doctor outside of a professional setting.

Here are a few updates from this rotation.

I am entrusted with breast exams now, in addition to measuring fundal height.

One patient talked about how she wanted some birth control and the doctor suggested something with 99% coverage and I was nodding in agreement, and the patient was all over it saying "well he seems sure that it works" as if I have intimate knowledge of it.

Another patient was telling the doctor about the pads she was bleeding through, then looked to me for some recognition on the type, as if I would know it well.

Depressive Symptoms

So, for most of my life since I have been aware of death, I have been really good with the concept. Chummy. Because death just means that we go to heaven, and since the purpose of a Christian's life can be said to bring heaven to those we encounter, well, it makes sense that death should not give us a reason to fear. The Apostle Paul expressed similar ideas, noting that to live is Christ and to die is gain; he had work to do on this planet, but he was super cool with the idea of being done with that work as soon as God wanted to take him out.

That being said, I have begun to wonder whether Paul was depressed. If I had that kind of work to occupy me, I think I could manage better too. But as it is, I seem to be suffering from subclinical depression. It first hit in medical school, which fits with the susceptible age range for people in their 20's. That and the fact that I am training to be a physician, the profession with the highest suicide rate. All of my nearby medical friends have the same problem as me, namely that we have no method of relieving stress, or of living life outside of school. We are all international students. We have all moved from various parts of the world to be here, and when we try to make plans, we usually have to do so well in advance. And we often do not follow through because we feel guilty about not studying.

It does not help that that trusted friend I mentioned in a previous post does not seem to want me as a friend. After I displayed a considerable level of trust in what I shared, she displayed a considerable degree of distrust. It has been a few weeks and that betrayal still keeps me up at night. I have not talked to her about it because for one, she does not want much contact, and two, I angrily wrote out three pages of frustrated anger at her over it.

Everything should be done out of love, not fear. When we act out of fear, it causes harm.

So I feel drained of whatever inspiration had carried me through my first rotation, that desire to work long hours to impress the doctor. After all, this pursuit seems so stupid now. In two years, if I match, I will finally enter into residency, which has high suicide rates. That is the big goal, what I and my peers are fighting for. We want the chance to be worked over to the point that killing ourselves seems easier. And we are not allowed to struggle with our issues. We are actually supposed to convince our patients that suicide is not the answer.

Actually, I just looked it up again. I am at least borderline for major depression at the moment. Increased sleep, loss of interest, lack of energy, difficulty concentrating, and thoughts of death. Granted, the thoughts of death really have been there since I was like ten, but it did not have the company of the rest of the symptoms.

I tried not drinking a few nights this week, but that just made things worse. I tried writing out my problems. I tried sharing some of them. But being so impermanent has led to my good friends being scattered about the country and the world. My closest friend in Dallas sexually assaulted me, and I have not had the initiative to let her know.

By the way, I genuinely do not wish to take my own life. I still have work to do, though it is admittedly a reason why I leave my shotgun back at my mother's house.

The depression just hit really hard today. The things that I suppose have made me feel so worthwhile in the past, well, I keep questioning whether I still possess those qualities. I cannot dance anymore, apparently. Am I still even funny? Do I... I just know that I am still quite far from my goals, and that even when I reach those goals, those goals are merely a stepping stone to reach real goals, and every point in the process seems awful and lonely.

The bright side in all of it is that I found that liking a girl made me happy. That is not a feeling that I typically look for, but once I grasped it, actually felt it, I was so afraid of losing it that I acted poorly with it. I let fear be the motivation.

Anyway, OB/GYN is turning out to be like pediatrics, in which I know nothing about it, so I have to study up. The doctor is not charmed by me, and since charm is all I have, I feel like my only advantage is gone. So I must study. Somehow fight through the depressive symptoms and study.

Visits Home During Transition

Visiting home again. I was here two weeks ago, and will be again for the next two weekends. I had forgotten how relieving it can be during a transition period to visit home. When I first went to college in Arkansas, I frequently made trips back to Texas. Eventually, I stopped wanting to do so. I began to prefer Arkansas. I made so many friends, and university life lends to that.

Medical school was different. I went to an island with differing people, cultures, climate, and an altogether feeling of separation from any world I knew. I spent a lot of time alone. The isolation brought about depressive states.

So now I find myself in a new place, but with a relatively easy academic schedule. I still do not know how to acquire a social life where I live in Houston, but I do have the relief of visits home. People who know my humor and already know what they can assume about me, who do not take my words so seriously. That is the worst thing about working in medicine thus far; people genuinely listen to my words if I introduce myself as a medical student.

In other news, maybe I will get to go backpacking through Central or South America before I start residency. Or Asia maybe?

Spent

Well, it appears that I have returned back to my old baseline. The knowledge that death would be preferable except that I have work to do here on this planet, the ever-encroaching loneliness... The difference is that I now know that those feelings need not exist if you open yourself up to someone enough.

But the emotional walls are going back up. I do not know another way to function other than to do so. Even with that, it feels as if I have only a tenuous grasp on myself.

I no longer feel that noble drive that once pushed me forward. Just lonely exhaustion. This psychiatry rotation has me questioning many of the spiritual beliefs which I had previously held. I still do not know where I stand on some of these things.

I just feel so spent. And... I do not know. In the past, I considered myself capable of making it through all of this through willpower and reliance on God, but it has taken so much alcohol to keep that method afloat. When I let myself become enamored with that girl, I did not even care to drink. I preferred not to, because why suppress those feelings? But no, I am back to this world of doing the right thing because it is right, of avoiding liking ladies both because my standards are too high and because I do not wish to hurt anyone.

And this is my easiest rotation. Maybe my next ones will drown out my ability to think about anything else.

All The Preparations

Sometimes I feel like I have been at this thing forever. That all of my preparations, all of the work I do to prepare myself for what is to come, that all of the studying and self-discipline, that all of the hours spent feeling so alone are not going to be met with proper fulfillment.

There is a doctor who had previously attended my old church with whom I get coffee when I can. After I got the news that I had passed my exams, that I would move on to clinical rotations, he asked something to the effect of whether I had my drive to become a doctor. I had continually reassessed whether I was to continue to pursue this. But my pursuit of a doctorate in medicine has never had much to do with my own desires; rather, it has been based on what I have felt that God is telling me to do.

Do I want this? I do not think that any other job would be so satisfying at this point... yet it seems as if that is what this would be: merely the least of all evils. Frequently saving and prolonging life is nice, I suppose. But... today, I was thinking about how I should not become a psychiatrist (still doing my psychiatry rotation) because I do not think I could very honestly tell, much less convince, people that life is worth living. I keep going because of this now-murky ideal that I could save the world. God gave me purpose in that. But I have always preferred the idea of just going to heaven, of passing away and being done with all this. Ever since I was maybe 8 or 10 years old. Part of me thinks that the reason I leave the shotgun I inherited at my mother's house rather than with me in my apartment is that I could have the potential to plan my own demise with it. I have never had suicidal ideation, but neither have I ever believed in keeping murder weapons around.

Part of the issue is, perhaps, that I somewhat recently experienced a big part of why many people remain alive. I attached enough feelings, became vulnerable enough with another human, that I was able to fill this void of loneliness in myself, and for the first time, I did not prefer to have this life ended. It was odd. I had half-prayed it before, but was never brave enough to voice the words. After all, how could one pray for an impossible feeling? I rarely feel anything. But there it was.

And now I am to abandon all trace of that feeling, to reverse myself back to my collegiate state, before I was broken by exile to an island, then sexual assault, then my current exile to the traffic-heavy yet academically light land of Houston.

Yet occasionally, there are days, like this past Saturday, when we have a patient who asks about the Bible. He asks whether Jesus ever actually claimed to be God. He was struggling in his faith. In my attempts to critically analyze, I have asked the very same question, so I knew that there was a time when Jesus had done so, at least to a reasonable extent. So I looked it up during the interview and told it to the patient before he left. Mark 14:61-62. It was moments like these that broke the camel's back, that led Jesus to His inevitable path to the cross. And it was a moment like this, when my years of consistent study actually yield anything.

Still though. Must life be like this?

Strong, Independent, Single Ladies

At a few points in my life, I have had friends who were quite pretty, delightful to get to know, and all around good friends. The friends of whom I am describing just so happened to be ladies. The tendency with these friendships is for the lady in question to have had a recent breakup and, shortly thereafter, decide resolutely to embrace being single. To me, this was a great relief. Being single has defined my life, and with the knowledge that I would remain single at least until my school life finished or stabilized geographically, I tended to simply want pretty single friends with desirable personalities.

But here is the thing about all of those instances: after a couple months of being so very determined to be single, they found their way into a relationship. It always felt a little like betrayal. After all, the terms were made to be very clear to me that they were off the market. They were independent and proud to finally embrace that. But then the apparently irresistible allure of an independent level-headed and reasonable woman would catch the attention of every guy, and eventually, her attention would catch on one of them.

So then this girl comes along. She is the best. Friendship is the best option, at least for now. She wants to be single. And she does not want me to think of her as a crush. She cannot help the feeling of fear that her not returning my affections will result in my being hurt. Whereas the only thing that I can see hurting me much is her throwing affections upon someone else, which, from my experience, seems likely. In addition, I have always had crushes, and am admittedly afraid of going without one.

However, it is foolish to allow one's actions to be driven by fear. So I am attempting to give up having a crush, give up her, and give up the fear of her finding someone else. This decision was further strengthened when I imagined not having her as a friend at all. She is too good for that.

Leaving The Promised Land

I am at an unpleasant crossroads. This girl is now my closest friend, and that alone is wonderful, but I am genuinely wondering whether it is okay for me to keep liking her as I do. For one thing, I have always had crushes, so it does help me to cope with being single. But I am also trying to give her and my desires for her up to God, to try to trust in Him to make a way if He wants to do so. She has guys after her right and left, and I cannot really help but feel somewhat jealous. When I try to flirt, she affirms her desire to be single right now, to avoid dating and relationships.

We tried to rush into things too fast at the start, so separation was healthy. For her, it would more or less have been a rebound thing. For me, well, it seemed to me that you do not write a love letter and decline when feelings are returned.

There's an ongoing theme in the book of Jeremiah through which I feel that God has been speaking in regard to this relationship. I have been far more hesitant now than in the past when it comes to making assumptions that God is speaking. After all, I do not wish to treat the Bible as a horoscope or something, just searching for something to match my feelings. Yet my conversation with her tonight, during which she demanded that I stop texting her so frequently, felt like a confirmation.

Jeremiah 24:5b-7 "I regard as good the exiles from Judah, whom I sent away from this place to the land of the Babylonians. My eyes will watch over them for their good and I will bring them back to this land. I will build them up and not tear them down. I will plant them and not uproot them. I will give them a heart to know me, that I am the Lord. They will be my people, and I will be their God, for they will return to me with all their heart."

He goes on to say that, in contrast, all who remain in this land, even though it is the promised land, He will make them "an object of ridicule and cursing" wherever He banishes them. He will send the sword, famine, and plague against them until they are destroyed from the land He gave to them and their fathers.

He is talking about the Promised Land. The promised land is a defining aspect of the Israelite faith, history, and culture. It is the homeland very specifically designated to Abraham at the time that God called him. And God is saying through Jeremiah that staying in that very same Promised Land will bring curses, and that going away from it into exile is actually going to make them better, stronger.

As dumb as it may sound, I feel like that girl and living near her is my Promised Land. Maybe that is just how I have to think of it for now in order to cope. In any case, I need to try to be present here, to live and put down a few roots, rather than to keep trying to reach her more. If it is God's will, He will make a way.

All Of My Issues

Okay, here it is. This is the trauma that I was dealing with a couple weeks ago. I had a dear friend read it, and she said that it did not change her perception of me. By now, I knew that that was the sort of response I could expect from her, but there are always the competing voices that imagine the worst replies. 

Sometimes, in contrast to the norm, girls chase boys.

The year was 2012. I had traveled to Uganda that summer and then preached a sermon that fall. Then, a week or two later, she came over to the blanket fort. Having been single for all of my life, I naturally have a desire to cuddle, and she flirted with me and had expressed similar desires. We had been friends for a couple years. Unfortunately, I did not know that she was sexually active at the time, though I am unsure of whether I would have been more cautious even if I had known. Hopefully I would have. In any case, we cuddled. She knew that I had had dreams which had made me form rules of no kissing or having sex. But as we were cuddling, she used her hands to guide our hips to introduce a vertical motion. Breathing patterns changed and I was suddenly doing something that confused me. We were fully clothed. None of my rules were technically broken. But then the guilt washed over me in powerful waves immediately afterwards.

Such an action triggers a release of oxytocin that helps to form a stronger emotional bond. She was still my friend, but now I had this odd fear of that guilt mixed with longing. Other opportunities arose, but I was a tease about it.

Fast forward four years. I had recently returned from two years of living on an island in the Caribbean for medical school. It was the loneliest, most depressed I have ever been (and lonely often seems most of what I am, so it is saying something). I had no prospects in the dating realm, and since I never dropped my standards, I felt as if I would never find anyone. Loneliness without hope. And election season was in full swing, with many I had had my eye on either choosing the wrong side or no side at all. It was a time for taking sides. Anxiety was quite present.

Anyway, she had gotten married while I was away. And birthed a baby. So other friends and I visited her apartment for some occasion and I stuck around a little after others had left, with the intention of catching up. She was smart and we had had a few good talks in the past. But although the memory has become more fuzzy, I remember a very sudden transition from nothing happening to her on top of me, kissing me. My body went with some of the motions as I became very anxious and confused. The baby was in a crib nearby and her husband was in the bedroom, as he had work in the morning. My main thought was that if he got up to get a glass of water, he would see this. And I would have ruined their marriage, their family. She asked “is this okay for you?” at a certain point and I did not answer except perhaps with a confused look. After all, it was never my intention to be a part of a married woman’s affair. (Once again, fully clothed and all that)

I had difficulty processing this. My usual approach is to blame myself for my part. But as in the past, it was more difficult with her, because she had sexualized things. Lust and objectification of her became a significant aspect of my thought processes for awhile. I had acne for a week, which really does not happen except when stress is notable. She was one of my few friends in the area, and that crude form of intimacy was my only escape from loneliness. I was just so resigned to a lack of hope. So another few occasions came about. The last such episode was in January of this year. She referred to it as flirting “a lot”, which I suppose was an attempt at softening the gravity of such awful actions.

Because of the election, I had stopped attending church. My close friends tended to be associated with her friend group. So I was more isolated, studying for an exam that I was doomed to fail, and trying to come to terms with myself and what I had done, along with the fact that I had intentions to seek out opportunities to repeat these mistakes.

I now had alternate selves with which I had to contend. I had the me that I had always been. Sure I liked to flirt, due to loneliness, but I kept my thoughts pure, never tried masturbating, and always sought to see women as whole people rather to than sexualize them. ‘Cause that’s what they are: people. This is a big reason why (in my opinion) couples are meant to wait till marriage to have sex, because we are meant to love a person as a whole. And I of course respect marriage. My parents’ divorce led me to respect the sanctity of marriage even more, as I see the devastating effects of their divorce even today. But now I had this other self, this one who was somehow willing to involve himself in a woman’s cheating on her husband in a mockery of the sanctity of marriage. These two moralities could not coexist in a person, and thus the seeds for an identity crisis were planted.

In multiple personality disorder (from what I remember from some audio lectures during my psych rotation’s drives between hospitals as I fought the urge to doze off), traumatic events can force someone to develop a separate personality for each aspect of themselves. We have separate versions of ourselves for parties, for intimate time with friends, etc., but in that disorder, the person’s personality supposedly fractures. I struggled for a significant amount of time to keep myself from fracturing over this. The main problem, I think, was that I was so very focused on what I had done in response to the trauma, rather than focusing on the trauma itself. I had not even considered it to be trauma, even though playing a critical role in the thing you hate and fear most in life certainly could be considered traumatic.

So I had simply considered myself to be guilty of something wrong rather than recognizing myself as a victim. And since I had no one to talk to about it, I left it at that and tried to accept God’s forgiveness. But that duality formed by hypocrisy remained. When I found my dearest friend (and crush), someone else with whom I had been honest and open from the start aside from this issue, it ate at me. She had spoken of herself as fractured as well. When we both affirmed that we were each other’s favorite person, what I had held back before began churning within me. I saw a movie with a rape scene and pictured her and became nauseated and cried; I have cried only a few times as an adult. I went to the theaters and after the movie, I was shaking and crying and nauseated once again. So I texted her to let her know that I needed to tell her things, but only in person.

I wrote this a year and a half after the fact because I did not recognize the impact of sexual assault upon my person. I blamed myself for the role I played, but I apparently cannot leave it at that. #MeToo I guess. Weird. To clarify, I am always responsible for my actions, but a review of my genuine beliefs leads me to think that this was my response to trauma in a period of great vulnerability. I don’t know if that helps or redeems anything. 

Issues Are Luxury Items

Having issues is a luxury. That is a lesson that I had to relearn this week.

Last week, I had issues. Affirmation of mutual closeness with a friend along with some psychiatry lectures led me to realize that I had some trauma in my life which I had not confronted. Not confronting it led to episodes of nausea and crying, the latter of which I have only done a few times in public. I will likely post about it soon, but as it is the first time in my life in which I have had issues, I want to talk them over with a trusted friend first.

I was reminded of how such issues are luxuries because that same friend's grandfather is currently dying. All of my issues are so small when I consider those possessed by others.

In other news, I took my pediatric shelf exam on Tuesday. Hopefully they'll let me know if I passed my first rotation sometime...

Psychiatry is really interesting. Apparently, most psychiatrists do not even believe in multiple personality disorder. This is reassuring, because my "identity crisis" sounded exactly like what those patients go through.

I had a happy hour Guinness today, so I am quite sleepy.

Oh, and it sounds as if I can obtain my MD by the end of next summer. That would be neat.

Psych Rotation

Psychiatry is fun. For one thing, this doctor is very busy and very good, so the students do not actually participate in patient encounters beyond observing. This is extremely relieving. I am doing my core rotations, but I met a student who is doing this as his elective rotation, which means that he has already completed his first year of clinicals. Conversing with him all day alleviated many fears, as he advised me on how I should live life a little bit while in Houston rather than stress myself out so much over studying. He went to the same school in the Caribbean, so he understood the bad isolationist habits that we all developed there.

Thanks to him, I also realized that with my current schedule, I can be finished with rotations and applications by next year in the fall, and match for residency is not until the following spring. So if all goes well, I could have a 6+ month gap in time which would only need to be filled by whatever interviews I get. In other words, I could travel. Even for the interviews themselves, I will have to visit wherever they are in the States.

Lots of fun patients in psych today, but my favorite told us that he was god. Specifically the reincarnation of Judas Iscariot. I do not quite follow the theology, but then again, I am no theologian. He also said that a witch doctor cut his heart out. When the doctor asked how, he said "I don't know how it works" in a sort of a "How would I know? I didn't go to witch med school"

There were many others. I should try to keep logs tomorrow so that I will not have to worry about logs anymore for the rest of the rotation.

Nothing Romantic

She is at a place where she does not want to think about boys or dating. And that is a healthy place. So I am no longer to think of her romantically, which is probably good, 'cause it consumed so many of my thoughts.

Though I would like to go yell at God about it (I thought He and I had cleared up some of these things last weekend), I begin my next rotation bright and early tomorrow. My mind feels somewhat relieved but also restive. I wish I had anything going on in this new city.

Make no mistake, I am glad that all of that happened. Maybe we will be come the people for each other someday, but we are not for each other as we are. I allowed myself to feel a lot, and it also got me writing a lot too. I had so little inspiration for most of my years that this flood comes as a relief, letting me know that that ability to write is still in me. If I go to a poetry open mic night, I will have something to share, and that is quite nice.

So now I am left with the ever-present question of how I can attain any form of a social life here? I have no relief apart from that which I find at the clinic, and one can hardly call a medical student's life at a clinic a "social life".

For now, I will have a drink and try to focus on the psychiatry rotation that awaits me in the morning. The mission, as always, is to obtain a letter of recommendation.

Talks With God

I finished my first core clinical rotation on Friday. The doctor told me that she would miss me and to call anytime. She said that I did an excellent job, and that I could request a recommendation letter from her.

I should have been celebrating after that. I did try. I went to the movies to see Isle of Dogs. And then to karaoke. The movie was good but made me think of that girl the whole time. Karaoke was not very good.

See, on that Monday, that girl had messaged me to let me know that my incessant letters were making her roommate assume that we were dating. This had implications of dishonesty on her part. So I was to stop writing letters. I had put one more in the mail that day, but told her that I would stop. And from that point, I became somewhat convinced that she no longer liked me. That evening, the thoughts of her did not interrupt my studying every few minutes. I accomplished more a lot faster. But then I had to correct my mind that night with no more daydreaming about her. For a night, it was okay.

The following night, the loneliness was crippling. I tried to just go to sleep, to just do what I have done for the bulk of my life, but her absence from my mind was so acutely disconcerting that I cried. I never cry, privately or publicly, with a few very specific exceptions related to academics. That night, however, my pillow was lightly dampened.

So the next night, I finished my tasks early enough to drink. I messaged her that night, checking to make sure that I was still okay to visit the following weekend, but she said that it would be too painful. I told her that I have put aside enough of my feelings to be a friend for her, and she too is depressed enough that she appreciates it. Though I remain convinced that she no longer wishes to like me in a romantic fashion.

My mind is in turmoil all week as a result of these assumptions. I do not allow myself to think of her romantically, to daydream of her, and it takes its toll. I always dream about a better day to come. I cannot help but to drink every night.

Fast forward back to Saturday. I work out, which I had negated for much of the week, and then I try to make myself go to a different karaoke. I think to myself that I need to get out, to live a little bit. But I walk in and wander for five minutes and simply cannot make myself stay. I felt wrong. So I left, but rather than drive straight back to my apartment, I pulled over into a parking lot in front of a park and began to talk to God.

Normally, in instances of frustration such as these, I make myself yell at God. I rarely see a reason to raise one's voice when trying to communicate, but for God, I think it important to churn up whatever I am trying to keep from Him. But I am so exhausted from the thought of not being with her, of the simultaneous reopening of that void of loneliness, that I merely speak. I had really tried to obey Him in this. A vision lent its support and that friend remains convinced of its validity. The missionary gave a cautionary answer that was "not a no". Logic said to give this up. I had moved away and it did not make sense. But neither does me becoming a doctor. So I cautiously told God that I would switch my thinking from the loneliness back to thinking that she and I were meant to be together, that if He wanted that to change, then He should absolutely intervene and correct us. And also importantly, I told Him that I would try to give up to Him my constant resigned suspicion that she would find someone else. If I trusted Him with the relationship, then I would also trust Him to keep her heart from other men.

That night, we FaceTimed. She had read my letters. The last one had included a list of qualities that were objectively admirable. It was only a page long, but she had mentioned that she did not see what she brought to the table, and that boggled my mind, so I figured that this may help. She told me that she was afraid that she would break my heart. I let her know that that was not her responsibility, that emotions are emotions, but I did not think that she actually could, given the nature of her character.

That conversation, which is the type of communication that I always long to receive from her, felt like a confirmation of the conversation I had had with God just hours before. We played truth or dare, and during that game, I dared her to visit me and write me a letter, both of which she agreed to do (though the visit was apparently still in the works from when she had previously told me that she would).

She said that I am not allowed to write her a letter until I receive one from her. I write poetry for/to her frequently, but simply have it saved in my phone, hoping for a chance to send it to her to capture her heart just a little bit more even though I remain 221 miles away.

Wrote This Last Night

I really have missed feeling things. Since college, I have felt far apart from such things. I backpacked through Europe alone. Why? To better myself as a person. I didn’t want to go alone, but I couldn’t find anyone else willing, and going alone was preferable to not going at all. It began as a mission trip for a week, so when I parted ways from my fellow missionaries in the airport, the weight of it hit me. That loneliness. Suddenly, I only knew maybe three or four people on the continent. And I had a bed and breakfast booked for the following night, but no plans beyond that, for the next three months. Loneliness. Loneliness in the most beautiful and romantic places in the world. Because this was the best way I knew to become a better person.

After I got back, I went to medical school on an island for two years. I was suddenly a racial, religious, and cultural minority in a place that, as I would go on to discover, has an odd culture of cruelty for no purpose except to be mean. And no ladies in mind except one or two that were back in the States. Even writing letters wasn’t practical from the island. Two years. Loneliness. Depression. Because this was the path to saving the world.

Then I got back to America and found myself an intellectual minority, and in the process, I exchanged the depression that came with isolation with the anxiety that comes with a 2016 presidential election. I wanted to process the past two years, but somehow I couldn’t come to a place for that. I felt like God told me not to go to my old church. I was confused on a spiritual level, and that helped lead me to deal with the stress in unhealthy ways. I compromised my morality, became unsure of my identity, and also lost the hope that I would meet anyone to partner with in this pursuit of saving the world.

Then I took a study program and met someone shockingly wonderful, who immediately got along great with everyone in the study program to whom I introduced her. But she was with someone, and by her mannerisms, I did not suspect that she was Christian.

Summer came and I moved to Arkansas to study for the big exam. I did so because home felt an impossible study environment and because I was trying to find myself. The last time that I had a firm grip on who I was happened to be when I was in college, in Arkansas. I reconnected with a friend who had just become a doctor, and became his social relief as his medical friends moved away for their residencies. I easily befriended all the strangers at the local small town patio style bar.

I took the test and do what I always do when I have a gap in my schedule. I traveled. I had never been to New York, so I drove there with very little plan for how things could work out. Nashville, D.C., Baltimore, NYC, Niagara Falls, Toronto, Milwaukee, Chicago. It was exhausting and difficult. Then I found out that I failed my test and drove home. I began studying again a few days later. I had also begun liking a girl, but as I got to know her, I became increasingly frustrated with the fact that she was my age and loved God, yet somehow had not felt the compulsion to travel beyond the local area to better herself as a human. I tried to like her because she was beautiful and going into nursing, but she didn’t have the spark. But she did have a connection to the old world to which my identity had been so intimately bonded. So I realigned my spirituality and morality. But my weakness is that without a hope of a partner in life, the kind that I’ve always felt that God has for me, I am prone to compromising my ways. So I was still dumb sometimes. But then I found someone who was a great many ideals in a human and liked me back. I had written to her with no expectation of return of feelings, not leaving myself vulnerable, just letting her know for the sake of allowing her to recognize her own worth, as she seemed to think much of myself. But she did indeed return the feelings. This is the first time that this has ever happened to me. Yet as with all things potentially wonderful in my world, there would naturally be something in the way. We had mere weeks until I was to move four hours away for clinical rotations. So we made the most of it, but the time finally came for me to move. And she continued liking me. She and her mom visited and she liked me then. We prayed about whether to try dating, but when she realized that little would change, that distance would remain prohibitory, she said no. And I didn’t feel peace about it. And counsel I consulted urged caution.

Even so, I wrote to her frequently, with ever-increasing intensity, until it came to a sort of culmination where the clinic was stressful and she was my only form of stress relief, and I became overwhelming in the affections that I poured forth. And finally, she asked me to stop writing. She understood how therapeutic it was for me, but the endless letters were causing assumptions from others that were untrue.

Thus do I find myself in loneliness again. But it is of a better flavor. She seemed ready enough to date after I made my feelings known. Distance, not affections, were what stopped her from wanting to be with me. This loneliness does not encompass all the vastness of space as it seemed to only a short time ago. This time, it only stretches for 221 miles.

Submitting The Idea To God

I FaceTimed with her after I wrote whatever I wrote yesterday. She is in the phase of happily being single into which I am always encouraging everyone else to enter, the phase in which it seems I will likely continue to dwell for the near future. It allows for personal growth and development, but the loneliness does hit rather acutely at times. I still have tentative plans to visit her, and she hopes to do the same to me, but I am trying to do better at submitting the whole idea of a relationship to God. God has someone wonderful for her, and it probably is not me as I currently am, and obviously potentially is not me at all.

So the letter I wrote today was a poem about the Bible, and I also typed (because it's way faster) a prayer about us to God. Oh, and a list of nice qualities which she possesses. I typed that too, 'cause it's a long list, and she had expressed doubt about what she brings to the table. I could not tell if that was about dating or saving the world or whatever else, so I listed things from multiple parts of life. And I left out her looks in all of these, 'cause I think she already knows what I think of those.

Not feeling that burning longing quite so heavily after putting pen to paper in this way, and after taking the time to submit it to God more, I already find myself drawn to drink. I genuinely did not want to drink to excess either when I was with her or when I daydreamed about her. She filled that void. I wish that God could fill it, and I suppose that He does sometimes, but there is a reason for the Eves of this world for stupid Adams like myself. Maybe I will find one someday.

Vulnerability Banishing Loneliness

This last week was difficult. I finally gained access to all of my weekly quizzes, so I now need to complete all of them during my final week of pediatric rotation. Fortunately, my next rotation appears to be very light. In addition to the coursework, a nurse practitioner was sick this week, so that meant showing up early and seeing patients every day with scarcely a lull. I was beginning to get used to the 3-hour lunches, and having that cut down to 45 minutes really put a hamper on my daily study quota. Hopefully the doctor will give me a good grade. She keeps telling me that I am doing excellent, and to keep it up, but I do not know if that is an 80% or a 100% or somewhere in between.

Also very much on my mind has been that one girl. Though we are not dating, this is certainly the closest I have ever come to such. Being in a new city with no friends or real hobbies present, I have been channeling my exhausted mind into writing to her. She told me she loved me when she visited, and I did not respond in quite as articulate a fashion at that point as I later wished I had. I have told many friends that I loved them, but it did seem as though this meant something else, and frankly, I have never allowed myself to be vulnerable enough to express such a meaning. And without God's express approval (which I cannot confidently say that I currently possess), that level of vulnerability seems unsure. But perhaps this is healthy for me, to allow myself to feel this much.

And that is the real concern. As thoughts of her become my only escape, my poetry has become more specific and impassioned. I was planning to write one letter per week, but I ended up writing four this week. And I have several poems already written in my phone. She said that she loves me, but now she seems hesitant, because the strain of distance, of not having me physically present, may be too much. Would our pseudo relationship continue like this? Just flirting long distance? For her, having experienced more, this arrangement is perhaps unbearable. For myself, I am shocked that the spot in my mind where loneliness had taken deep root has instead been occupied by her. I did not know that the loneliness could be displaced to such a degree.

My next rotation schedule allows me the opportunity to visit her, and for her to visit me. I hope that we at least have this time together. I am trying to submit it to God, because this seems as hopeless as the prospective of my becoming a doctor. My grandfather proposed to my grandmother by post, but judging by the past couple weeks, she seems unwilling to reply to a significant degree either by post or FaceTime.

Waiting In The Unknown

Life seems full of questions right now. I have been unable to complete any coursework for school because the website has been malfunctioning and those in charge have only said to be patient with regard to anything else. I have requested to take my exams, but I was apparently supposed to do so at least a week ago, so I do not know if that will turn out. On the bright side, I had my mid-rotation assessment with the pediatric doctor with whom I have been working, and she told me that I am doing excellent and to keep it up.

And there is this girl. Some of my fears were alleviated with the contents and interpretation of the vision mentioned in the previous post, but that friend was also excited for me, so we must all proceed with caution. After all, one step forward here is a step toward marriage and a partner in changing the world, so taking that step without surety would be quite foolish.

We FaceTimed briefly tonight. I told her that it is hard to be unbiased in my prayers over this, but I feel at peace as far as I can tell. I had also mentioned it to my dad on the phone earlier today, which of course made it a little more serious. I asked her how she felt in terms of which way God is pointing, and she said that she did not want to say. So that allowed a (probably healthy amount of) doubt to enter my mind.

Perhaps she is having second thoughts at the idea of us trying to keep up a relationship from 221 miles apart, which I understand. It has just been strange to not feel so very lonely, to have a recipient for these feelings beyond my notes or blogs. I am used to being an echo chamber.

I want it to work out with her, but I want to obey God's will even more. So I will await the response of my pastors and, you know, the Lord God Almighty Creator of Heaven and Earth.

A Vision

Amidst the doubts mentioned in the previous post, I happened to have a conversation with Cassie, a friend who remains (relatively) close since our middle school days. In fact, she was one of three ladies that I have ever asked God about dating, the reply to which was closest thing to an audible voice I have ever heard from God (a very distinct "NO"). I mentioned this girl to Cassie, and the interrogation began. Do I think about her, miss her, etc. and yes, all the time constantly. I mentioned my doubts about how she seemed to be starting out in her faith, not knowing the references to Sodom and Gomorrah (it was a funny YouTube clip), but she told me that her husband did not grow up like we did either, that he would not understand the reference.

I explained that I have not even asked the girl out because I like her so much that I am afraid that God will say "no" if I ask Him about her. And as I was debating this last week, another friend announced their divorce (or separation maybe, whatever), which did nothing to assuage my fears. And this girl and I have only known that we mutually like each other for almost six weeks, so I did not want such a decision to be fueled solely by emotions. But then Cassie stopped me 'cause she had a vision. It was of a water wheel. "The water is actually falling straight down in the picture I kept seeing. The water is falling onto the wheel from both sides and yet the wheel only goes in one direction (forward) and I didn't understand for awhile because that doesn't make sense and also sometimes I have to look a little bit closer. I believe the water may be the emotion and yet the wheel isn't propelled by that. It is still steadily moving forward. I also don't see the motion as a bad thing. The water is clear and crisp. Do not be afraid of it. It looks like a blessing. A gift."

"Ah, so the propellant is from heaven rather than emotion? That's the vision interpretation?"
"That's what I'm feeling. Yes!"

So perhaps it is time that I started asking God, along with the few I know and trust to hit me with the truth, about this girl.

The Tough Questions

I am nearing the end of my third week of pediatric rotations. I keep getting very low scores in practice tests either because the information is very new, or because I am sucking at what I should already know. The questions are difficult and I am not fast enough. The doctor will be reviewing my mid-rotation performance in the next couple days, and I hope that I am doing well enough in her eyes. She controls 40% of my grade and I am beginning to doubt myself, but we will see.

The girl I like and still seems to mutually like me back keeps occupying my mind. I mailed her a poem today. I do not want to mess with her emotionally, but then again, I currently feel more feelings than I know what to do with (and that seems like the appropriate time to write a poem).

She texted me today with questions about faith, the kind that all of us should struggle with at some point(s). There are lots of religions, and everyone thinks that they are right, so what makes Christianity the real one? Being a good person seems like a nice enough thing, so why not leave it at that? My explanations, like all spiritual ones, were primarily subjective, as I freely admitted. She did say that she is still a Christian, and wondered whether these questions were okay to be asking. I of course encouraged her to keep asking, since God does not want us to just be dumb ignorant followers.

I had put that letter in the mail mere hours before, and at that moment, the primary reservations I have had about her seemed to crowd the forefront of my mind. Questioning is healthy, but what if she falls away from the faith? Her foundation is not like mine, thoroughly entrenched and with a widely professed path toward missions work. She has lived like a person and then found the faith on her own. I hope that she meets Jesus in a deeper way through this, rather than being left as a great many friends have, wandering with a sort of contentment in spiritual insecurity.

Maybe I should not have sent the letter. The thing is, I do not even have to try to like her. She is incredibly likable on a number of levels. I can easily see her doing missions work. But the reason for the mission work, the mission itself, Jesus Christ, has to be at the forefront of said mission. Without that, without the spiritual fulfillment that comes with the work of Jesus in one's life, all we are giving is a temporary physical fix. I am in medical school for the temporary fix so that the doors may be open to provide a spiritual one.

Having her fill my thoughts has made me feel considerably less lonely, which has been a welcome gift that came without request. I now understand why people date without asking God, how they can marry without being absolutely sure, and I have a taste of what it is like to not want to die early. Best case scenario, she tackles the tough questions and comes out of it loving Jesus, God says that we should get married, and life gets...happy?

But my bets are on struggle, loneliness, and barely dealing with the difficulties of life.

P.S. The girl I was liking in the fall, who helped to trigger my lil' identity crisis, has a boyfriend now. Jaw so square it must have been chiseled. She is great, but I am glad that I did not go for her.

After One Week of Pediatric Rotations

Just as was predicted by every blog about pediatric clinical rotations, I have become ill. It is only a sore throat, and mild enough that it can almost be mistaken for allergies unless I go too long without a cup of tea, yet it remains.

Though I would like to blame it all on pediatric rotations, I did have guests on Thursday. The lady I was liking before I moved is visiting Honduras with her mother (who hails from that nation), and to do so, they flew out of Houston. I urged them to avoid paying for a hotel by staying with me due to the frankly excessive amount of space I have in my apartment. The lady was ill enough that she had been sent home from work the night before, but we still cuddled in my blanket fort of a room for the hours of the night that remained before they had to leave for the airport.

So I either became ill from the many children I saw in the clinic this week or from the one close encounter with someone dear to me. In either case, it has so far only been a very mild sore throat, mild enough that I was unsure whether it was merely from allergies.

The coursework for the rotations seems pretty easy, aside from the exam at the end. Everything else is just taking a good history and giving a good physical exam, followed by submitting some fairly thorough patient notes.

There are certain procedures that my school says I should be able to do before the end of this rotation, but I do not see how it can happen in an outpatient setting. So we will just have to see.

Beginning First Clinical Rotations (Peds)

I should have been writing more, but a certain lady was occupying the parts of my mind and spare time that were not stressing out about preparing for these clinical rotations.

Maybe I'll be smart enough to catch up this weekend, but if not... since my last post, I moved to Houston where I am now staying in the nicest apartments I have ever had the pleasure to occupy. I have constructed a blanket fort in the bedroom and created a little work space in the corner (the desk was already built into the apartment).

I have completed the second day of my first core rotation in pediatrics. What inspired me to actually begin to write was the most shocking thing to me about my rotation thus far (aside from how kind and pleasant my supervising doctor is): children get diagnosed with serious things when they are really young. Our encounters are brief, and I have only seen so many, and all were already established patients, but it seems as if the most fun children, the ones that I liked most at a glance, have been diagnosed with ADHD. One patient today was especially amazing, as he and his sister, who had too much energy for their mom, were doing cartwheels in the waiting room and making fake phone calls with me through the window. They were smart and funny for their ages, at least without the medication. Another one was quiet throughout the visit, but apparently just cannot handle his emotions when something bad happens; despite the mood swings, he was making 100's in class and his teachers used him as an example. The pediatrician would end up adding conduct disorder (which seemed an extreme diagnosis to me) for lack of a better understanding of what exactly was going on.

My mom never used those medications and did not take us in for testing either, and I think I am the better for it, even though my attention span has never been what I could wish. I just wonder, if the parents of these children could spare the time and energy, whether this medication would even be necessary.

Weekend Following Valentines

Having someone like you in return is weird. It seems treacherous. I have not asked God about her because I am moving in a week. She is also in the midst of making life changes to become a better human and Christian, as am I, but if I was a betting man, I would not expect God to give the green light for us as each of us are now. No matter how much of a delight that would be. Maybe I should write out all the things I like about her. Maybe I will start writing letters. Well, perhaps I should not. She will likely find someone else while I am gone.

I have been researching apartments in Houston. On the advice of a friend's friend who lived there, I am probably going to be paying twice as much as I have ever paid for an apartment due to the need to avoid bad neighborhoods. A thousand dollars per month seems crazy, but on the bright side, each one looks like a hotel room at a resort. The resort style pools, fitness centers, and game rooms are not hurting anything either.

In other news, it turns out that I have been leading someone on for a long while. I have rules for a reason, but I dance around them. Though I feel as if I made myself clear on how I go about the dating process, flirting is not harmless. It resulted in confusion. So that is a good reason to be moving. I apologized and threw the blame on myself because that is easier than placing it on anyone else. I get the feeling that I am better than most people when it comes to writing out my issues in order to process them. I can deal with things better than most, so I will take on the burden when I can. Because once I get it figured out with God, it is no longer my burden. Anyway, I spent much of today feeling terrible about how I had made her feel.

Valentine's Day

Most single people seem so bitter about Valentine's Day, but it manages to be one of my favorite times of year. Christmas is big on presents of course, but nothing allows and excuses overly gushy gifts like Valentine's Day. Due to my parents' divorce, I have many fears about my ability to be a good husband, but I know that I can be the best on Valentine's Day. Making origami gifts with accompanying poetry is my jam. That and performing are the only two things that I know I am good at doing.

I only made two this year. One was for a good friend who is currently divorcing her husband. The basic rule for these valentines is that they are meant to keep my good pretty lady friends from going through Valentine's Day without being made special to some extent. Since I assumed that she would not be feeling so special in that regard, I of course made one for her. The other I made for another friend who has been a welcome breath of relief for me.

I have written about her here before, and she still seems an oddity. Too many good qualities in a human for her to still be single. She got out of bad relationships fairly recently, and I am about to move away for two years (at least), so it would not make sense for me to ask God about her. The timing just does not work. That being said, I wrote her a poem that expressed these things a week ago, and, in the meantime, found that she feels at least somewhat similar toward me. This is very off-brand for me, to have feelings be mutual. I have playlists and writings and desires set aside for when things become real, with the assumption in the back of my mind that these will never have their place aside from when I want to write sad poetry on my own to embrace the pervading loneliness. Thus far, I feel as if I have only really fallen in love with places. Belfast, Edinburgh, Paris...

Since I am always moving to new places, no person has felt permanent. Cities are safe things in which to fall in love. Also, I do not like the term "fall in love", at least not as casually as a great many people seem to prefer it used. Feelings being so faulty and variable, I just do not see it as an initial thing. First you make sure that the logical side works, and then you throw feelings on top of that.

Anyway, this is a weird Valentine's Day. Even a pseudo-real valentine is a weird thing.