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.