The Medical Internship Sumarized.

This post is mostly directed at myself.   For my mind to keep track of the events of the past year, how was the mood curve like and the potential triggers for worsened depression.  I took advantage of my blog maintenance to dig through the files and make some sort of index of what happened during my medical internship that started on July 1st 2007 and hasn’t ended.

Is it going to ever end? Nobody knows.  At the moment It feels like a psychological open wound.  You can just look out the window.  And escape.  Fast.

Maybe uncertainty was better?

How uncertain.

Well, I officially feel like crap.   I took time off, I didn’t feel ready to go back, but I did it anyway.  It backfired.  I crashed down, and now I add another failure to the list (for my mind to torture me with), while the ghost of something unfinished hovers on my head not planning to go anywhere anytime soon.

This is all too recent yet and my brain has too many knots right now.  I probably won’t make a good post, although it’s been weeks since I don’t, so what else is new.  Long story short, I crashed, like I always do, but this time I was not that messed up, and I had a bit of hope that I would do something different this time.   I did something, but it didn’t work.  I basically got laughed in my face, while someone else implied that allowing me to graduate would drop the school standards.  I just sat there, not knowing if I should fight, or accept the charges, my brain was spinning.   I have better grades than the average student, even WITH depression, I got a scholarship worth of a semester in 2007 because of my grades.  I might not be in love with my career, but I do it well.  I pay more attention to the patients than so many people I’ve seen, and I am very good at analizing cases and get diagnosis and solve problems.

The only bit is that I’m too unreliable. I’m good but have no resistance.  Give me some extra hours, and all the good things I have dissapear and are replaced by crazy bugs that shut my brain off.  I become distracted, erratic, my cognitive abilities dissapear, my mood goes completely insane.  How could I keep a job on this? How could they let me graduate and go make the school name look bad when I fail at the “real jobs”?

I asked whether they’re evaluating skills or just the ability to work like a slave.  Know all those morons that barely scrapped through and got drunk everyday? Well they graduated just fine because they pretty much have no need for sleep.  That was the big requirement I didn’t live up to, so go tell me about fucking standards.

At the same time, I see their point.  I’m not running a bussines by my own.  I have no authority here, rules are there (who knows where they came from or why, but they’re there), and the only thing they know is that I broke them.   The morons didn’t… or at least didn’t get caught.   I don’t even feel the support of my psychiatrist anymore…

See, the school system works different here than it works in other countries.  I basically finished high school, then entered university, and I haven’t had another graduation ever since… I mean, we don’t have that system of the US where you do 1) College 2) Grad School (Med school) 3) Internship as the first year of a specialty.  No.  When I signed up for the first day of “college”, I signed up for all the years to come.  Internship is the last year of med school as opposed as the first year of an specialty.   If an intern in the US fails at their intership, all they lose is a few months.  They don’t lose their MD tittle, they can go into something else.  They of course don’t lose their college degree in whatever major they did.

If they don’t allow me to graduate, I would have lost 7 years.  I would be just a 21 year old with a high school diploma.  Now talk about serious problems.  I had bad depresion episodes when nothing bad was going on at all, but because of this I caused actual problems that now haunt me down.

I now have an official reason to be badly depressed, gee, I should throw a party!

Beyond the sarcasm, I feel like hell.  My brain will not forgive this.  I am already swimming among horrible thoughts that I can’t get out.  It is only downhill from here.  I’m not even surprised.  After all, I often feel like I have nothing to live for.  All I had was my dreams, and they’re not available anymore.  I feared a moment like this. You can say I’m still alive and “healthy”, but I seriously don’t care.  I was thinking earlier that I would gladly donate my life to someone who really wanted to live, but for some reason or another is now dead.  It is not possible, but I am so disgusted, I feel like I’m carrying a life I don’t deserve that someone gave to me by mistake and really belonged to someone else qualified enough.  I feel like I caused all this, how could I not? I’m a human adult, not a kid.  I don’t get to play the victim.  But I do (victim of circumstances, biology, mental illness, environment… you name it).  And this adds another ingredient to the disgusting salad that is my head right now.

The glitch is always here

I’ve been having problems with my internship again.   The exhaustion is getting the best of me.  I have been doing my shifts but I haven’t been able to work during the day.  I only want to sleep, I’m always so tired…  And, I’m in trouble, because you can’t just not work.  I don’t stay home, I go all the way to the hospital and crash on the dorm beds to avoid family questioning.

My brain brings its own cake to the party, with these thoughts that are already very familiar to me:

“if you can’t do this, then what can you do?”

“You will not be able to stay in any job”

“You will never be independent”.

“If you’re not independent what’s the use in living?”

And my brain is not the only one who says it of course, it’s what you would expect colleagues and bosses to say, and they do.  But I can’t do anything about the other people… the main problem is my own brain thinking it.

See, if you get badly hurt or sick (physically), your body does some adjustments.  Among them there’s one called Blood Flow Redistribution.  Lets say you have an accident, get hurt and lose lots of blood…  your body will immediately enter in “emergency mode”, and send the blood that is still available to organs like the brain and the liver.   Conversely, it limits the blood flow to organs like the skin, gut and kidneys.  So you get pale and stop producing urine but your brain and liver are trying to survive here!  It doesn’t mean your body “thinks” the skin or guts are not important…  I mean, you cannot live without skin or guts.

It’s just a matter of priorities. You want to protect your brain more than you want to protect your gut right now, because your priority is not digesting food right now. Your priority is staying awake (brain) and trying to survive whatever has happened to you.  It is producing clotting factors and proteins (liver) that will keep adjusting your body for survival.

Jumping back to the mental world.

I have already mentioned levels of activity before.  Lets bring the list back for a sec.

Getting out of bed, and taking care of basics.

Getting out of the house.

Potential socialization

Working – easy

Working – medium

Working – difficult.

Working – difficult + extra time.

Going up is slow and painful but you can fall in a blink.   With the restart of the internship and the shifts every 3 days, I jumped to a level seven, when I was at level 3 just a couple of weeks earlier.   My mistake, but in the practical world, intermediates are hard to get.  Plus I have this urge to finish!  I don’t want to be sitting in 2009 with 3 months of internship still left…

I felt it was too much for me, but something in my brain told me – “you cannot sit and wait until you think you’re completely ready.”  It could take years… it could never happen.  I might always have some residual depression.

I want to be working and active, but I have so little energy now that all I can do is sleep, eat and sort of take care of myself.  It’s not that I think working is not important… but right now all what I care about is not falling even deeper mood wise.   I haven’t been suicidal or extremely depressed yet, but I after so long, I can recognize the signs when I see them.   I can’t focus, I want to be alone all the time, and then I feel bad when people actually leave me alone.  I can’t do math… the most simple things prompt me into using the mobile calculator.  Cognitively I’m good for nothing and prone to error. I’m up and down, and for no reason I want to cry, and for no reason I get laughing fits.   I kept a mood journal from August 1st, until yesterday,  hoping that maybe my perception of things going wrong from memory might not be accurate.   But I re-read it today.   I can see myself falling with every passing day, trying to do things to cheer myself up, feeling better temporarily, but still following a clear curve down.

The medication was sort of working, but apparently I am not quite there yet. Does this mean I shouldn’t be working? I know the way that road takes me:  Dropping off again, suffering for weeks in guilt feeling useless and stuck, doing nothing at home just waiting for it to get better…

I gotta say that this time I feel like I have lots of additional support that I didn’t have before.   Something needs to be done right…. I’d hate to go down that old road again.

I asked my psych doc for help.   Help me work something out.  Help me talk to the people in charge.  I need to finish, how could I not?  I have done this for almost 7 years, I have never failed a subject despite it all.  Make the schedules more free for me.  I’ll show you that I know my stuff, but I can’t handle the immense pressure right now.  I don’t plan on working as a doctor, but the degree would be extremely useful for me to pursue a more theoretical career.  I am not a bad student at all, I just need some hep.

I feel ridiculous requesting a softer treatment, and the first that suffers is my pride.  But if I don’t do something I’ll drop out again for sure.   And that would be catastrophic.   When I re-read what I’m trying to ask it doesn’t look that impossible.  But I have been trying to talk to my immediate boss since Monday and I have absolutely no idea of what to say.  He approached me today and told me that I was failing because of unjustified unattendance.

I opened my mouth to explain but my brain went blank.

Night Shift Nightmare

I stayed on the computer today to return emails,  comment on blogs and update my own blog.   But I wasn’t completely successful; I’m not too talkative now.  I am okay, mood wise.  It is stable, apart from irritability that is mostly due to sleep deprivation.

That is probably the only issue I’m facing right now.  Back then, everytime I had to pull an all nighter for some reason, the only way I got away with it was by having the whole day off afterwards.  On that day off I would die on my bed for nearly 20 hours and I would still remain sleepy during the week afterwards.

I was very scared of the internship because of the shifts.  How could I handle not sleeping for a night and keep working during the day? Impossible.   And here we’re talking about starting your day at 4:30 am on one day and ending it on the afternoon of the NEXT day.

It has probably been the worst of the internship.  But okay, you can get tired.   Later I had the horrible relapse of depression and the little energy I had stored was completely depleted, along with the sense of it being worth it at all.   It wasn’t worth it.  Neither was living really… it brought back all the mental garbage I had stored for years.   Triple team attack on my mind.

I am for the moment, stable in reference to depression, but the shifts are something I am dreading terribly.  Nobody likes night shifts, but when they’re working they seem to forget about it, sure they look tired, but they work anyway.  With me, I’m always having the urge of going out of the hospital and taking a taxi home and never returning… I’ve done it before, so I know it doesn’t end good.  I contain myself and go back.  The next day my brain is a completely useless piece of crap.    One day after a shift I was madly laughing for no reason, and throwing the paperwork on the floor and going away to eat not caring about anything and apparently I told people things I would not say normally.    But what happens more often is that I go into a mental state where I hear nothing, understand nothing and see nothing.

Lately that I don’t drink any alcohol at all, being sleep deprived is the most similar thing I have to being completely wasted.   And I feel guilty.  Everyone must feel bad and tired during the night shifts, but they work anyway, am I just weaker or lazier? They can’t possible feel the same I feel and keep on working, something must be different…

In my rational mind, I am aware that every human has different tolerance to sleep deprivation.   Some people need 8 hours of sleep a night to keep their mind healthy, some only need 5 or even less.   Some people see sleeping as a waste of time.   For some of us it is like breathing.   My brain has high requirements of sleep.  It always has, since I was a kid, and it never changed.  Only maybe got way worse when depression worsened, but I think the need for sleep has always been there anyway.  If someone came to me with this problem asking what is wrong with them, I would tell them that nothing is wrong, that they just have higher requirements of sleep and should figure a way to work and study adjusting to those requirements.   But what if you can’t?

On my last shift, at 9 am I fell asleep in the interns room and I didn’t even remember how I got there.  I remember I had to go back for another round of patients, but I didn’t.  I am avoiding the resident because I know she’s probably upset.  But people warned her already about the intern who is smart but not dependable… what a reputation.

I am a horrible person when I am sleep deprived.  I am irresponsible, immature, rude, don’t care about anything or anyone, make inappropriate comments, and SLEEPING goes on the top of the priorities list with nothing that can beat it.   I don’t like the person I am when I am sleep deprived and mostly that is why I absolutely dread being sleep deprived, and it sucks to feel so out of control.

Thinking

I’ve been reading a friends trip day by day in a new blog.   I’m loving it.  I think I have always fantasised about the idea of finding someone’s little old journal on a street, not knowing who it is of, not sharing it, just going into this person’s head.   I suppose this is why I like blogs.  I get to know so many things about people without having to engage in ages of small talk and superficial behaviour to get such level of depth after a long time.

With blogs I feel like I have free access to several passages in people’s minds.  I can wander unknown (lurker), or I can decide to identify myself and sometimes they get into my head too.

Then I stole the idea.  Not in a blog.  I am in sort of a routine, so posting about it would be really boring.  No, I am only trying to complement my mood journal.  It is known that for mood disorders, the last advisable thing to do is to rely on your own memory to determine how things have been going lately.  It was one of the reasons I started blogging before anyone besides me was reading.

Today I wrote something like this (extreme summary of several notes all throughout the day.)

1. Hard to wake up.   REALLY hard to wake up.  Will not wake up… *wakes up*.
2. Can’t get a hold of myself!  I barely showered and put on scrubs…  A whole day is still waiting for me.  Luckily my father drives me, because if it was up to me, I would have stayed home.
3. Got to eat something, plus an energy drink, and the attending disappeared for 1 hour.  The rounds won’t start until a while…  I have time to calm down.  Please calm down.
4. Fucking boring routine. *works*  But nothing exceptionally bad has happened.  *surviving mode*
5. Oh! Iguanas! *takes photos* I have to accept this day has not being exceptionally hard.
6. Fuck! 20 more patients? I am so tired.  I have a 36 h shift tomorrow.  I had an all night shift on sat – sun.  How am I ever going to handle a night shift every 3rd day? plus the full time work during the day? I will not… I will not… I can’t.  *panics*
7. My last shift turned out quite happy in the end because of one nice event.  I can handle this.
8. I can’t depend on a person! I cannot be this dependent.
9. I am not dependent…   maybe I should learn to rely on someone for a change.
10. The good thing about today was that I learned to do ultrasounds on pregnant women and actually UNDERSTAND what is going on in that screen. – wow, I like something about medicine.  Strange.

I finished with a rather good thought.  But the whole day was full of anxiety.  But I survived.

I can be on the verge of freaking out, but the day might actually finish off just fine.  I need to remember this for the next time I freak out.   Maybe I will still freak out, but at least I won’t freak out about freaking out so much…

No, I did not understand that either, don’t you worry.

Crossing a Scary Pond

I have been trying to avoid talking about myself as such lately.  It’s just too much.  I haven’t been depressed, not like before.  I suppose the meds are working.  [insert excited exclamation]

But I am reluctant to admit that I’m feeling better.  Because I’m scared.  This happens… my mood lifts one day, but soon I’m in the bottom of the pit again.  I can’t allow myself to build my hopes up.  It is too dangerous.

I dropped out from my medical internship almost 3 months ago.  If I hadn’t I would have graduated already, and I would be a MD, ready to do general practice or go into a residency.  Not only it was the fact that my depression worsened and I couldn’t handle doing the most basic things anymore, but I have never been too certain when it comes to my career choice either.  If I wasn’t even able to do things that I usually liked to do, much less things that I didn’t.   But then I don’t do anything about it either, I don’t quit for good, I don’t study something else.  I have nowhere to go.  A friend keeps telling me that no one really likes to be in medical school because it’s too fucking exhausting, but they do it anyway and they feel rewarded later.

For some reason I don’t think this is the case with me.   They try to motivate with the prospect of money, and I don’t even care.   And I do want money, because I want to travel.   Travelling needs money.   If I had teleporting powers, and an endless supply of coca cola, I would not want money really.  I’m very low maintenance.

But life isn’t magical, and I have already decided in different moments and under different moods, that what I need to do is to finish.  Just graduate and see what happens next.  So that’s the plan.   For reasons out of my control I cannot prolong my break any longer even if I don’t think I’m quite ready to go back yet.

I start again tomorrow.

I’m really scared.  My self confidence is in the floor.  I don’t doubt my knowledge, I doubt my mental strength.   I probably will be able to handle one day, two days… what happens after the first shift?  Sleep deprivation is extremelly damaging for me.   It’s like my neurotransmiters deplete and my brain turns off.  What happens after two or three shifts and after the exhaustion builds up again.   These are the ingredients that have most often led me to morbid suicidal ideation.   What if I don’t really kill myself, but I can’t take it anymore and I drop out again?  To me that’d be worse.  There would be zero confidence to ever ride that boat again.  My self efficacy would be irreversibly dead.

And like I reasoned in my last post, when someone dies, it hurts, but the world keeps on spinning.   I am sure that if I die many people would be incredibly wounded, but it’s only a matter of time and future joys to get over me.  They WILL get over me.  That kinda gives me a green light.   And that is not good.

I’m supposed to start tomorrow and not flip out until Nov the 30th.   I’m supposed to graduate.  And I can’t see anything beyond that.   This is a pond I need to cross, but I feel like I didn’t bring any flippers or lifesavers.  It’s just me and the pond.  I’m not ready to swim, but i’m being throw in anyway.

I don’t know what’s going to happen.  But I’m terrified.