a young pakistani doctor blogs...
Thursday, June 30, 2005
  A better day.

It was a good day today. My “island” retreat is working. I’m able to get the work done without feeling panicky. Its seems that I always have something to fall back on if I screw up these days, and that really helps me to de-stress. The exams don’t seem like a life-or-death struggle anymore. I’m just plodding along and working and not letting my fear get in my way. I made a good, workable time-table to get everything done in time. I worked 8 hours today. Less than I would have liked, but a good day still. I also watched Patch Adams on cable. Great movie for would-be doctors. It does something to rejuvenate the spirit of a medical student in his final year preps. Let’s hope tomorrow works out as well.

Monday, June 27, 2005
  My own island

Six days have passed. And what has this almost-one-week brought with it? A great deal of enviable studying? A total cure of all my ills? The birth of a new me? None of those things. A vacation, lots of soul-searching, confusion, and a wee bit o’ hope.

After that first day I spontaneously decided to take off, I followed it up by 5 more ‘spontaneous’ days off where I forbid myself from fretting over studies. I told myself sternly to try to relax. “Deep-bone relaxation” I called it.

It worked. While I’m not falling over myself to whip open a book and start studying with the fervor of the newly converted, at least I don’t get nauseous at the thought it. After six days, where I never even tried to work, and never worried myself over work, I feel somewhat refreshed. It’s not the Second Coming to be sure, but its as near as I’ll get to it. Today, the thought even crossed my mind that I would enjoy studying from now on. I don’t expect that sentiment to last more than five minute after opening the books again, but the notion that there is still a little chirpy, endearingly naïve side of me is comforting. My soul has not been completely crushed in the epic battle with med school. A vestige of the childish enthusiasm still lives. Atrophic and brutally battered to be sure, but still alive.

But while I’m feeling a little perky now, the last 6 days have not all been so centered. I’ve had a whole lot of inner struggle going on, as opposing convictions battle each other for dominance of my mind.

You see, I’m a medical student, and if all goes well, in the near future I’ll be a doctor. But the road to financial independence is about 3 years away. I’m 25. That means I’ll be dependant on my parents for sustenance till the ripe old age of 28. Only then will I be able to leave the mother nest and live life on my own terms. Life under my parent’s terms – not so great. I’m fiercely independent-minded and my restlessness will be difficult to chain down for another three years. Specially since my parents still treat me like I’m a kid (don’t you hate it when they do that?).

Enter a fantasy I’ve harbored for the last 3 years. Writing.

I like to write. I’ve written and been published (short stories and articles). I think I’m good. I want to be able to escape all my current woes by writing my way out of my ‘troubles’. I really really feel I can be a great writer. I have a lot of contribute as a writer. I can chronicle a piece of the world most people have never read about before. How many Pakistani English writer’s have connected with world-wide English readers? Err…Zero. Lots of Indians, but zero Pakistanis. There is a gap to be filled, a chronicler from my world. I could do it.

In my fantasy, I sit down sometime after my final year exam, write frantically to get some 30,000 words down, send it over to “someone in publishing” in the UK and get an sufficiently large enough advance for me to take the calculated risk of taking a year off to finish the book. Hopefully that book will sell well enough for me to contemplate a career in writing. In the following 2-3 years I write a couple of more books, which also do well, cementing my financial security.

*Cough* Yeah, I know, It’s far fetched. Incredible even. But I’ve read up on young writers to whom such a thing has happened. I know, I know…it’s very rare.

So is it just a pipe dream? Am I living with my heads in the clouds? Fool’s paradise?

Well….who’s to say? No one can really. Maybe I’ll be a great literary sensation. Maybe my book will disappear in a month’s time to the endless abyss where forgotton books are cruelly discarded, along with the dreams of their authors.

There is something in me that tells me over and over, with conviction that I have the talent. I’ve read mainstream writers, and many times, when reading the book I realize I’m much better than this. ‘This guy here, he’s published a book, it’s here in my hands, he’s making money off his writing. And I can do better than this!’ I’ve written before and been published, and my work has been really appreciated. Sought after even.

I know if I get into medicine any further, I’ll abandon the entire writing idea. This is not a theory but a fact. I will not write. Why would I? I’ll be a hot shot doctor. When I’m in my residency, I’ll be too busy to write, and when I’m further up the ladder, I’ll be making too much money to want to make the effort.

This time. This is the time. I may give it a try, and even if its not a huge success, just a small one - I’ll be encouraged to keep trying. As long as I can keep myself afloat and not wallow in poverty, I’ll be content with my returns. If I don’t try now, I’ll probably never be motivated to do it again. Wouldn’t that be tragic if there really is something great in me that’s just waiting to be tapped into and expressed? How many great English writers have come out of my country? Zero. How many doctors? One, follows by a whole bunch of zeros. If I’m a successful writer, I’ll be unique; able to give something few others can. If I’m a doctor, I’ll just be successful.

I’ve been back and forth, believe me. And its agonizing. For one thing, I’ve got a major exam starting in 59 days. Is all this musing just an escapist mechanism? Am I just so sick of studies I’m creating an ‘out’? Am I just giving myself something to latch my self-respect on to? Do I feel a sense of being overwhelmed by this exam and am creating a way to conquer the feeling? Maybe, maybe. It’s very possible. Keeping that realization in mind, I made a pact with myself.

Under no circumstances can I allow myself to do badly in this exam. I can’t let dreams of an unproven future allow my on-the-ground future to be jeopardized. If I make it as a writer, that’s great. If I don’t, I need to have something to fall back on. So medicine is my cop out (not writing). I’ll work hard for the next 3 months to pass these exams with good grades, but I’ll utilize every break I getting b/w studies to read a good book (reading is like prepping up for writing. You can’t write w/o reading). I’ll work 2 hours at a stretch, then take a 30 minute break by dipping into a novel. The novel will keep my soul alive and hopeful. It’ll remind me that I have a dream beyond my dry medical books. It’ll help me return to those medical books with a bit of enthusiasm and hope. Those books won’t be the end of my life. Knowing that there is something else for me will remove the life-or-death grip of fear these exams have for me. I’ll pass these exams, then I’ll settle down to write for 3 months. Then we’ll see what happens. I feel more eager to study now that I’ve got a relief.

Remember the movie Collateral? When Jamie Fox is explaining his ‘escape’ to Jada Smith about his ‘escape’? He said when he got too stressed, all he’d do is escape to his island. Then he pulled the sun-guard down and pointed to the picture of his island. He said he’d just block the world out, and go to his island. It helped him to de-stress. It helped him to keep on going.

I guess I’ve found my own island.

Thursday, June 23, 2005
  A day off...

Thursday, June 23, 2005

How did I do yesterday? Well, good and bad.

The bad part of yesterday was that I didn’t study. Not a stitch. I was feeling sleepy, bloated and stupid most of yesterday. I’m not sure why. It may have to do with fitful sleeping the night before. When your studying, you’re really sensitive to your inner state of mind. The subject matter is boring enough by itself, you don’t need further problems. Any excuse to take the day off is welcome, and if I’m feeling weak, taken up. But I can never take a “day off” without making some sort of resolve to avoid putting myself in such a situation again. It was difficult for me to study because of the way I was feeling physically (at least that’s what I told myself). So I had to analyze the situation and cough up a remedy that I would apply the next day to ensure that something like this did not happen again. Well, I did come up with one, but its so trivial and stupid that I’m just going to come out and admit that I just didn’t feel like studying. No sense in hiding my weakness with far-fetched excuses that barely have a leg to stand on.

The good part of yesterday is that I didn’t freak out. I felt calm and told myself to relax. I didn’t beat myself up or allow myself to fall into the throes of self-loathing or depression.

Let’s see how today turns out. In the meantime, check out this wonderful prose from the book “White Teeth” by Zadie Smith:

Darcus Bowden, Clara's father, was an odoriferous, moribund, salivating old man entombed in a bug-infested armchair from which he had never been seen to remove himself, not even, thanks to a catheter, to visit the outdoor toilet. Darcus had come over to England fourteen years earlier and spent the whole of that period in the far corner of the living room, watching television. The original intention had been that he should come to England and earn enough money to enable Clara and Hortense to come over, join him and settle down. However, on arrival, a mysterious illness had debilitated Darcus Bowden. An illness that no doctor could find any physical symptoms of, but which manifested itself in the most incredible lethargy, creating in Darcus admittedly, never the most vibrant of men a lifelong affection for the dole, the armchair and British television. In 1972, enraged by a fourteen-year wait, Hortense decided finally to make the journey on her own steam. Steam was something Hortense had in abundance. She arrived on the doorstep with the seventeen-year-old Clara, broke down the door in a fury and so the legend went back in St. Elizabeth gave Darcus Bowden the tongue-whipping of his life. Some say this onslaught lasted four hours, some say she quoted every book of the bible by memory and it took a whole day and a whole night. What is certain is, at the end of it all, Darcus slumped deeper into the recesses of his chair, looked mournfully at the television with whom he had had such an understanding, compassionate relationship so uncomplicated, so much innocent affection and a tear squeezed its way out of its duct and settled in a crag underneath his eye. Then he said just one word:


Hmph was all Darcus said or ever was to say after. Ask Darcus anything; query him on any subject at any hour of the day and night; interrogate him; chat with him; implore him; declare your love for him; accuse him or vindicate him and he will give you only one answer.

"I say, isn't dat right, Darcus?"


Wednesday, June 22, 2005
  I is be back

The phone line and thus my internet connection was cut off till yesterday, and now here I am again. I feel like my writing is a little strained and rusty. That’s one thing I know for sure about writing. If you’re not reading and writing a lot, then writing is a relatively painful process. The words don’t come out as easily, and you feel more conscious of your writing.

How have I fared these last 2 weeks? Well, I went to Peshawar to handle some loose ends over there. I ‘wasted’ two days in the journey there. I ‘wasted perhaps two other days during which I did very little work. The problem is, when I’m not blogging, it hard to keep track of my progress. You loose sight of the ‘big picture’ when the little details are not written down everyday. You are left only with impressions of how the days have passed. This is especially true for me, as I hate thinking about my progress objectively. I’d much rather indulge in the escapism that objective impression provides.

The ‘vibe’ these days is good. I feel okay. I just hope part of that is not due to me being at home, far from the college and the library where legions of my class fellows drudge away at the books for obscene number of hours. Being far removed from ground zero might be giving me a false sense of security. Its funny how I never considered this possibility till now, as I’m writing this blog.

I’m definitely on the move since I last posted. I’m not sitting down moping, but getting work done. I’m not getting it done nearly as fast as I’d like, and I really have to accelerate to finish my targets till the end of this month. If I don’t, I’ll be in biiiig trouble come crunch time, a month from now.

These preps are long. I’m only now beginning to appreciate the absurdity of one enormous exam that has officially been sanctioned 5 months of study time. Five months! So much can happen in five months. Its escapes being called ‘half a year’ by a measly month, otherwise it would seem more formidable that it does now. I’ve never been in a situation like this before, where I had to study continuously, and hard for such a long time. The longest I lugged it out before was 3 months for my fourth year exam, and in this 3 months, I’m counting 2 weeks of exams as well. This final year exam I’m studying for lasts for one and a half month. So that’s five months of studying for the exam, and then an extremely hectic one and a half month in which the exam, with its 9 written tests and 7-8 oral ones are spaced out. Of course, during this one and a half month, the studying will accelerate. But by that time, we’re running on adrenaline and naked fear. The studying just happens by itself.

A day to day blogged progress report from now on should give me more objective overview of my progress. I can look back over the days and see if my studying is consistent.

Wednesday, June 08, 2005
  Internal machinery.

Whenever I eat a carbohydrate-rich meal for dinner, I always have a ‘hangover’ of sorts the next morning. I feel really sleepy in the morning regardless of how much sleep I had the night before. I can’t focus at all and generally just feel like crap. I remember once, about a month ago, I had a lot of peanut butter just before going to bed. Peanut butter has a lot of sugar in it. The next morning, I felt as if I were going to die. There was absolutely no way I could concentrate. My eyes were burning, my legs were feeling weak, I was depressed, and just wanted to lie down and sleep for a couple of months. Thinking that perhaps the sugar had something to do with this, I decided to stay away from excessive carbs in the evenings. I even cut down on the amount of bread I ate. The next morning, I woke up fresh, alert and energetic. I was bursting with energy. I thought I was on to something, so I followed the same principle the following night, staying totally away from simple sugars after 6 pm, and having little carbs in my dinner. I woke up fresh and alert the next morning! I had definitely made a discovery. I’ve tried the Atkin’s diet and it gave me increased energy levels too and now I understand why.

In much the same way, I’m coming to realize that a lot of my depression, anxiety, and self-doubt is intimately tied in to my studies. When I’m working hard and getting things done, I feel I have not wasted the day and I feel great about things. However when I don’t do any work, I feel bad about everything, quickly descending into depression that can sometimes make matters even worse. Its another discovery about myself. I am happy when I’m productive (when I have to be, like during these preps of mine). When I don’t honor what I feel are important responsibilities of mine, like working hard to make something of myself, I feel really bad.

This, like the carb thing, is perhaps an idiosyncrasy of mine. Maybe it’s not. Maybe others feel the same way too. Nevertheless, what it means is that my internal circuitry is programmed to always push to be my best. My happiness is tied in with the fulfillment of my responsibilities. In a way, this is a blessing. There are many who find it all to easy to be lazy; many who don’t have a conscience. I’m lucky in that way.

Tuesday, June 07, 2005
  The write way to study!
Hello boys and girls out there in blogland,

I studied more today than I have for some two weeks! I'm feeling so nice and relaxed. A lot of the anxiety I'd felt over the last two weeks has dissolved. Whew! I feel I've turned the corner and am truely on the road to lasting recovery now.

I decided in the morning that I would condense the text I was reading by transcribing the salient points into notes. I found that writing the stuff down actually made me move faster. I would read the text, decide what was important and what I could do away with, then I'd write them down in my own words. And I didn't get very tired either. I was actually enjoying myself a little bit. I'm going to tackle the rest of the course this way as well. Write write write. While at first, writing stuff down might seem like the slower way to go, it actually speeds things up.

I didn't study that much today - about 7 hard hours. But that's more than what I've done in 2 weeks. Tomorrow I'll aim for 10 hours and then a study 12 hours thereafter. Wish me luck!
  Nothing to fear but…
I barely did any work yesterday! I started off with my study-break routine, and was doing well in the beginning. I faltered in the 2nd hour and by the third, sputtered out completely. I couldn’t bear to pick the books up again despite numerous resolutions during the course of the day to just do it! Consequently, I was more irritable yesterday afternoon and evening than I had been in a very long time. Man, was I irritable! I was snapping at everyone and everything. I wouldn’t have wanted to be around me!

At night however, I had managed to calm down, although through no great self-control of my own. The skipped heartbeats and palpitations stopped and the crease in b/w my eyes softened as whatever demon had possessed me up till then decided to cut me some slack.

It was my father who calmed me down. He was very loving towards me last night, and expressed confidence in my abilities. Whenever someone I know about does that, it really calms me down. When someone honestly believes (and expresses this belief) that I am capable of making something of myself, it increases my self-confidence. As other med students will know, self-confidence is a rare commodity come crunch time in med school. I know I have it in me to be a great doctor. I know I can do really well in this exam. That is to say, I know I have the guts and inner strength to lug away from the major part of the day at my books. I’ve done it before. Its just that sometimes, when things are moving too slowly, I panic and start to feel I’m slipping, and before I know it I am slipping. I think a major part of this insecurity and lack of self-confidence is my repeated failures in the past. When I was younger, before med school, I led a happy, easy, obstacle-free life. I used to achieve my goals with great ease. Failure never loomed in the horizon, so fear never did either. Now, both seem to be constant companions of mine, dogging me like bounty hunters. The fear induces panic, and the panic causes a total breakdown of focus which lead me right to failure again. A positive feedback loop.

One way of breaking the cycle is to succeed at the task at hand. But why should my inner self be subjugated to the capriciousness of my performance in an inherently flawed examination? Shouldn’t I be positive and self-confident regardless? Isn’t building a fairly resilient character part and parcel of the process of medical education? This career will throw other curve balls my way, in other shapes and forms. If I break down and let fear of failure overcome me, I’m already a failure, aren’t I?

Most of my study woes stem from an inability to perform because I get so freaked out, I just short-circuit myself. One way to break the cycle is to be realistically positive. Take it one day at a time, pat myself on the back for the work I do, and not dwell too much into what I have yet to do.
Monday, June 06, 2005
  Its hard.
After a huge cup of coffee, I’m still feeling fat, sluggish, slow and useless. And I’m also feeling bloated. It’s a new morning, but a sound night’s sleep and lots of cable last night did little to rejuvenate me. Sometimes I wonder if my state of mind would improve if I had really good, fun friends I could relax with. Or having somewhere to go to hang out. As it is, my greatest hope for relief from the tedium of books and pressures of exams is watching cable. But I hardly know anyone here in Islamabad and there is little one can do in Peshawar for recreation. Stuck between a rock and a hard place.

But mebbe I’m just trying to rationalize my feeling when that’s not really possible. I mean I find this study stuff difficult. I get fed up quickly and have to force myself onwards. But maybe that’s how it is! Let me tell you something two friends of mine told me, both independent of each other, both scoring 99s in their Step 1. The older one told me that when he studies for long periods (like 10-12 hours a day for weeks), he feels suicidal. He says the depression is almost unbearable and went on to elaborate on how much he hated studying. Yet here was this guy who scored so highly in his step 1 and studied incredible periods of time to achieve that. He also said something that made a lot of sense. He said that if studying medicine were fun, everyone would be a great doctor. Its only because medical school and the material we have to cover for it (and for the Steps) is so difficult that few people get into medical school in the first place, and even fewer of those go on to become really good doctors.

The second once saw me staring mournfully at my book. We were sitting at the same table. He was studying for the Step 1, and would go on to get a 99. A very hard worker, this chap. He told me never to wait for the day when I’d actually enjoy studying or feel motivated to study. He told me that day would never come. He said this very eloquently with an emphasis on the word ‘never’. Hearing that cheered me up because it meant that I was not the only one to find this material mind-numbingly boring and tedious to the point of being torturous. It means that I don’t have some inherent defect regarding self-motivation. It just really is that hard.

Who can honestly say that they would be able to actively memorize material for 10-12 hours a day for 5-6 months without ever getting depressed and overwhelmed. You’d have to have the emotional range of a carrot to carry on like that without feeling down about your situation.

Lets have that second cup o’coffee and get back to work! It’s 9:15 am. I’ll have a cuppa, then start the study-break-study-break routine again.
Sunday, June 05, 2005
  A turning of the tide?
I started off with my lofty goals. After blogging the last entry, I got to it - brute memorizing the infertility chapter in gynecology. I managed to get the first hour of study done before I got my break. I know I said I'd do one and a half hours, but I couldn't manage it. The first hour went okay. I took my 30 minute break, then started again. The second hour was wasted day-dreaming! Not all of it, mebbe 30 minutes of it. I stared at the book though for the whole hour, trying to concentrate. I took my second 30 minute break then waded back in to the fascinating world of fallopian tube patency testing and the like.

The third hour of studying was hard for me. I emerged for the 3rd 30 minute break much like a man breaking up from the water for air. I felt suffocated. Not a good sign! I was reaching my saturation point too quickly in the day. The third break last 3 hours! I tried and tried to bring my mind back to the book, but just couldn't bear it. It was soooo dry! I puttered around for just a while after that, trying to get back to the study-break-study-break pattern of studying, but around 7pm, I knew that I lost the tempo.

Not all is lost though. After a 2 week dry period, which is eons in prep-mode-time, mebbe thinking of a full-blown, all guns blazing return to form on the very first day was asking too much. At least I can say it was not a totally unproductive day. About 4 hours of studying overall, which is a modest return to what I hope will be a more productive state of mind tomorrow.

To make things more interesting, I'm going to have all the surgery material I need in front of me as well. When gyne seems to be choking the spirit right out of me, I'll simply switch to something else. I have to get around to surgery sometime anyways. The problem with surgery is that we don't have a book besides Baily and Love's Textbook of Surgery, which is not for med students. Its too detailed, and very badly written to book. I'm going to hunt around for an online surgery book I can use. Anything's better than Baily and Love!
  Today's game plan and yesterday's progress report
I'm sorry to say I didn't study yesterday. I just lugged away at the gynecology book for 30 minutes, then stopped. Not entirely my fault though! The electricity kept going out and coming back till 5 pm. It was difficult to get anything done because of that.

Well, its a new day today, I'm feeling well-rested, a good night's sleep behind me, my second cup of coffee doing me wonders. I'm feeling up to it. Today will be different and will end my bad study streak!

I'm going to study for one and a half hours and then take the 30 minute break. I'll do this for 12-13 hours and hopefully should get about 10-11 hours of hard studying under my belt. I'll let you know how things work out! Wish me luck people!
Saturday, June 04, 2005
  A new beginning…

Its been about 14 days now since I haven’t done any work at all, save for a day or two of short bursts of studying in which I did some gynecology. If I told some of my friends this, they would look at me as if I were a doomed man, as if they are seeing me off as I walked towards my execution - with the mixture of fear and fascination you feel when you slow down to drive past a really bad road accident. I’ve put a big fat lid over the well of panic and regret that is turbulently gushing underneath me to get out.

But today is the last day of the old me, and the first day of a new beginning. It marks the first day of the process in which drPak gets his shit together, thank you very much! I’m using this blog as a crutch. Knowing that I’ve got these thoughts out here in cyberspace provides a degree of comfort to me. As if when I declare my weaknesses, and then my objectives for the coming time, I somehow have a better chance at succeeding. Maybe it’s just a place where I can be totally honest about everything and not try to persistently hide aspects of my personality from people around me. It really is a lot like a catharsis.

Sheesh, I’m still sluggish. I woke up an hour ago and the huge cup of coffee I had hasn’t helped. Let me have another before I get back to you….




…I’m back. Its several hours later. I got another cup of coffee which did the trick. The electricity went out 4 times in the last 3 hours, a rare occurrence, and I couldn’t get back to blogging or to starting my day as a ‘new man’. Anyways, its past noon now, and the minutes are ticking away so I’d better get into gear and start working. But first a list of goals for the remaining 25 days of June. All these goals regard studying and reforming my study habits. I plan to finish off 3 subjects, all of which I have started already by the end of this month.

  1. Finish the remaining 75 % of Surgery.
  2. Finish the remaining 90% of Gyn/Obs
  3. Finish the remaining 99% of Pediatrics.

Ok, looking at that, I’m starting to feel veeeeery uneasy. I’ve just realized how little I’ve done. *gulp* Okay okay, calm down. Get a grip.

What I used to do before with regards to studying is to sit down in the chair and tell myself I wouldn’t get up for the next 10-12 hours unless it were to go to the bathroom or for coffee. There is a reason I took this totally stupid and unrealistic approach. There is a guy, a friend of mine, who got a 99 in Step 1 and a 99 in Step 2 CK as well. The very first mortal I’ve met whose achieved something so difficult. He used to come in at 9-10 am, sit in his chair and get up 12 hours later. He did this everyday for about 18 months. He was so friggin impressive in his commitment that he practically spawned a fan club of medical students who all tried, but failed, to be just like him. He would never take a day off during those 18 months, and would not eat anything during the entire day. “Food makes me drowsy, and I can’t concentrate.” He explained when I asked him about it once. He remains a very modest and humble character and a person I admire very much. Obviously when I try to sit continuously for as long as I can, it is a feeble attempt to emulate this very intelligent, hard-working, accomplished, and well-liked character.

Further, since I used to study in the library, the long periods I spent sitting in the chair hunched over my books would also, in my pathetic mind impress my fellow library-goers. Several of them said as much. That’s sad. To think that at my age, I still require approval from my peers to feel good about myself. Sez something about my own sense of self-worth.

I’ve decided to follow the pattern of study outlined by jhawke at med school blues. She wrote that she studied for and hour, then took a 30 minute break and repeated this cycle until 10 hours were up. A 30 minute break after every hour seemed really excessive to me, and is certainly something I am not used to. However, upon considering the study-break-study-break concept carefully, I realized that if one sits down for a total of 12 hours (not uncommon at all amongst my class fellows) using this pattern of study, then it amounts to 8 hours of total study time. That’s quite a lot considering that this will be 8 hours of quality studying. I know from experience that as much as 40% of the time I use to sit continuously, staring determinedly at my books in the library would be spent unfocused. The concentration would just not be there 40% of the time. More importantly, the end result of studying in these intense bursts is that I get exhausted after a week or two and spend the next week or two miserably incapable of looking at the books. What is the point, then of attacking the books head-on for a week or so only to find myself totally burnt out for an equal amount of time later on. My study should be of a pace that is sustainable. If I burn myself out, I’ll ultimately fail in my objectives. The mind, I’m beginning to learn, is a tool, and as such its use must be properly learnt. This antiquated, alpha-male idea of studying like a demon for hours and hours seems to be more about proving something than getting the job done. That is the case for me anyway. I just wanted to show everyone what big balls I had. Look at me now, I’ve up an left the library, packed my books and ran home. I spent 2 weeks doing nothing, the anxiety levels just shooting through the roof as day after day dropped by unused and unavailed.

….not that any of this was ever obvious to me before writing this blog. Writing it out forces you to think. Reading other medblogs has also really helped. I’m not the first medical student in the history of the world, and not the first one facing these study problems. It seemed that it took the writing of this blog and the perspective gleaned from reading other medblogs to see the obvious inefficiency of my (previous!) study habits.

To think that I only have to look at my books for an hour at a time, to think I can indulge myself in any activity for 30 minutes in the middle of the day in order to keep myself fresh… its such a novel concept. I’ve known people who’ve study this way, but I didn’t really understand it (those people seemed so cool to me, they’d seem to be goofing off whenever you walked in on them, and they always ended up getting great grades! Now I hope I’ll become one of them!)

My house is in Islamabad. My college is in Peshawar. I’m in Islamabad right now. Been here for 2 weeks. I love this city. It’s clean, my house is very comfortable, my comfort and freedom from the banality of laundry, groceries, etc… is ensured here in Islamabad. Peshawar on the other hand is the a s s h o l e of the world. It’s dirty, very overcrowded, full of illiterate, ill-mannered, stupid people. It is a very very ugly city, in every sense of the word ugly. In all its ramifications and extrapolations, Peshawar is an ugly place. I don’t want to go into a Peshawar-bashing tirade. My friends have had many earfuls on the subject from me.

I had I have to go to Peshawar in a few days to take care of some business. I hope to return after a few days of stay, and then remain in Islamabad until mid August when I’ll have to go back for my exam. The exam will last a very very hectic one and a half month. After its over, I’ll be free and God-willing, if I pass, I’ll be totally free from Peshawar.

I hope when my studies gets back on track with the study-break-study-break pattern (I’m putting a lot of hope into it!), my visit to Peshawar does not derail me. I like things to stay the same when I’m studying. Well, I have to go back for a few days. I just hope I can maintain a good pace of study when I’m there.

Friday, June 03, 2005
  More on an introduction II

My current gripe.
I have my final year exams starting in 83 days. That is not a lot of time, because the amount of material I have left to cover is immense. I started studying for the exam around March. It’s the 3rd of June now. Since then, I can fairly say I’ve studied some 6 weeks altogether. The rest of the time, I just got sick and tired of studying and just flat out stopped. That is not to say I enjoyed myself instead – on the contrary I just lay about somewhere feeling miserable and low for not studying. If I feel I’m failing in my objectives, the low self-esteem really kicks in and has me feeling just about as important as a sack of crap in the overall scheme of the universe. I lose confidence in myself, stay indoors, tend to avoid people, look for ways to escape myself and my circumstances, I overeat… the works.

But six weeks of studying overall is not bad going really. That’s probably more than what most of my class has clocked in. At least I like to think so! I have a good chance at coming somewhere in the top 10% of my class if I get my act together and start studying properly. That’s one of the reasons I’ve decided to start a blog.

For now, since the upcoming exam is the Most-Important-Thing-in-the-Universe-in-the-History-of-Mankind, this blog will be mostly dedicated to following my progress (or, God forbid, the lack of it!) in my preparation for it.

And of course, the ramblings that result when my mind wanders to issues I shouldn’t be thinking about when I’m “hard at work”. Ha ha.

I’ve had a bad five years in medical school. In the college (they don’t call it medical ‘school’ over here- and my institute of learning is a college, not a university) I go to, it lasts about 5 years, not four. We’re old, broken men and women by the time we are spit out of the tail-end of the system; as opposed to the bright-eyed, enthusiastic youngsters we were entering it.

In Pakistan, there is no concept of a pre-med undergraduate degree. You decide to become a doctor at the very tender age of 16 when you enter a pre-med high school course that lasts 2 years. So you end up entering medical school at the age of 18, and you’re spit out at the age of 24. I’m 25, a year older than most of my classmates because I lost a year down this long winding road. I’ll save the story of the lost year for another day.

As I was saying, I’ve had a bad 5 years here. I’ve always been, throughout my innocent youth, a top student. When I came to medical college, my faith in my academic abilities eroded very fast. It’s a process that continues to this day. Everyday I spend not studying (when I should be) is a blow to my self-confidence. And believe me, I’ve had many many blows struck against me. I’m bruised and battered on the inside. This blog is a way to get a grip on all that emotional gunk that has build up over the years and try to just deal with it! I have to get past myself if I’m to succeed. What is success? Here are my current goals:

I don’t have an exciting life. My mind is ravaged with thoughts of, and the tensions of studying. This has been going on for 5 years now. As for the current final year exam, I know it’s very tough to contain the entire course of final year medicine in your mind for a month-and-a-half-long exam. It takes its toll, and I know for a fact that I’m not the only one who finds it difficult.

But I’m different! I’m better than the rest who do find it difficult and who get panic attacks every now and then. Aren’t I??

No, I’m not. But I wish to be. I want to be strong, well-balanced, confident, and consistent in my efforts. I’ve failed in one subject or the other in the preceding 4 years. Each failure has been met with a colossal loss in my self-confidence and self-esteem. I wish to turn all that around in a grand sweep by passing my final year with great grades. I guess I’m putting a lot into my success in final year. A lot depends on it. My parents have watched me descend the academic ladder I was once at the top of with no small degree of foreboding. They’re worried about me and my ability to deliver. I want to relieve that disquiet, both in their minds and in mine.

I live in Pakistan. I am a Pakistani, although I was born and raised (i.e., till I was 17) in Saudi Arabia. Mine is a poor country, and being an “upper-class” here is the same as being low-middle class in the west. A middle-class in this country (and this group forms the majority of the population who are not officially poor) struggles to make ends meet, struggles to enjoy their lives. A middle class man in this country may very well not be able to take care of his family all the time. He may fail by being unable to pay for any medical expenses he or his family may incur, may fail when it comes time to put his kids in a good school, may fail by not being able to afford a car, may fail by being forced to live in a combined family with (God forbid!) his own parents until they die and he’s 42 and inherits part of a house he has to share with his 3-4 brothers.

I don’t want that for myself. My father was poor. He was born an orphan. His mother died soon after he was born. He struggled and struggled till he got a PhD and a good job in Saudi Arabia. I was born shortly afterwards in Saudi Arabia. Now I’m all grown up, and my father looks to me to be able to take the torch and carry it even further than he did.

I’m a final year medical student. The most important time in my life, the most critical time in my life is coming up. I need to get my shit together! I want to be in a position to take care of my parents when they get old(er). I don’t want them to die thinking I’ve failed them, or even worse, that they failed as parents.

Hey, why is final year so friggin important anyway? Chill out, why doncha!
Good question!

I’ve got three brothers. Let me talk about two of them. One is older. The other is younger. The younger is a friggin genius, and is doing very very well for himself. Pretty soon, he’ll have a great job (in the computer programming world) in the States. He went to America recently to do his masters in a very prestigious university. He’s my family’s success story. The older one, in stark contrast is a ‘failure’, as defined (fairly, I think) by my father. After ‘high-school’ in Saudi Arabia my father sent him to Europe to get a bachelors in engineering. To cut a long story short, he didn’t get the degree, and instead flushed some $ 60,000 of my father’s money down the toilet. He just stopped studying, wasted his time there and finally, after two years over the time it would have taken him to finish the degree, my heartbroken father brought him back.

Two stark extremes, wouldn’t you say? One is my father’s pride and joy. The other, a source of heartbreak. One moving on to great things at the tender age of 23, the other still living with his parents, barely making ends meet with a shitty job at the age of 35. And here I am right in the middle. Which way will I go? Which brother will I follow? My parents are concerned.

My marks (i.e. ‘grades’) in my first, second and third year of medical school were no good. My first year was absolutely horrendous. My second year better, and third year a little better still. However, in all 3 years, I flunked a subject and had to take it again - a source of great disappointment for my parents. Fourth year, I finally got through in the first time around, but then too only by the skin of my teeth.

Now here I am in final year. For those who haven’t read my previous posts, the stupid medical college I go to has an annual system (as opposed to a semester system). We have one giant exam on a certain subject lasting 3 hours which, when graded, will represent the entire years’ effort. Till that exam comes, there are no quizzes, no regular timed smaller-scaled exams, no assignments, nothing. The exam is not multiple choice either, but essay type. So people who can write really fast and really neatly always have an edge. So you come in on a fateful day, take the written exam and that’s it – your whole year summed up in a 3 hour orgy of writing. Its insane. There’s been talk of reforming the system, but I’m leaving the college soon so I don’t really care. The uncaring, uninterested, unmotivated teachers who failed us so miserably can take their talk of reform and their solemn self-righteous pleas for change and shove it up where the sun don’t shine. A plague upon their houses! [I do hate them so. They’ve betrayed the trust they’ve been given to educate.]

I’m sorry, I got carried away! So much that’s eating me up, frustrating me. These pressures! (God, I’m such a whiner!)

Anyways…back to the final year exam thingi. Its important because what I do in it will be sort of a metaphor for the new me. A good score will show that I’ve truly changed, that I’m truly taking command of my life and am back to my former glory days when I used to be at the top of my class all the time.

The thing is I’ve gotten engaged. I am now linked inexorably to a wonderful woman. Can I provide a good life for her? Can I live up to the promise of the capabilities that I know I have? Can I master my capriciousness and study when its time to study, no matter my mood? Can I get my shit together? I hope so. She’s trusted me a lot. Getting engaged in my society to a person of your choice before you’re financially independent is a tricky proposition. I’ve managed to do it, but only after promising everyone (i.e., my parents, her parents, and her) that the day when I stand (very firmly) on my own two feet will surely and truly come. If I can’t pass a friggin college exam after all this time, after all these promises, then can they trust me to take command of my life in the future? Can they look at me and treat me like a man, and not some repeatedly fumbling, incompetent, weak, undisciplined loser?

The final year exam is a real test. I made promises. I told people I’d deliver. I have to now. Back to the wall and all that, you know. It will determine how much they trust me to guide my own future in the coming year or two.

And what happens in the coming year or two then?
After I pass my final year exam with brilliant grades, I will proceed to study for my USMLE exams so I can work as a resident, and later as a fellow in the US for a number of years. The USMLE exams are very very tough if you need to score highly in them, and I, as a Paki doctor-to-be do need to score very highly in them. Unlike many doctors/medical students in the US, we paki doctors (actually, all foreign doctors seeking further training in the US) need high scores to get into respectable programs in the US. I’m talking about 90s high. I’m hoping for a 99 on at least one of them.

High scores equals to good chances of getting a residency in the US equals to financial independence equals to the final hurdle to self-sufficiency and ‘success’ as defined by my society, my family, and therefore the universe. It will also mean that my parents will finally be able to rest at ease in their old age, content in the knowledge that the torch will be carried on, and that all the hard work they put into raising me, all the sacrifices they made in giving me a good education, all that has paid off. I want both my parents to rest easy in the twilight of their lives. I want to be able to shield them for a change, to provide for them for a change, to tell them that they never have to worry about money again as long as I’m alive.

But if I don’t do well in final year, how can they believe such a day will ever come? How can I? They’ll worry incessantly about me until my feet land in America and I actually go to there to work – if that ever happens! They’ll keep treating me with no small degree of justified distrust, worried that this son of theirs may never make it all the way like they had once believed he could (and would).

How can I trust myself if I don’t deliver in final year? I know I have it in me. I have to clean up my act. No more whimsical, stupid escapist day-dreaming (I do a lot of that – may write about that soon). My success will determine the happiness of people who are so dear to me. I can’t afford to let them down.

Blogging all this is so cathartic. So motivating. So mind-clearing.

More on this so-called important final year exam.
We, and by we I mean the other carbon-based life forms that are my class fellows, have been given 5 months to prepare for our final exam. These 5 months, when we don’t have classes and are free to study, are called the preps. These 5 months started on the 25th of March. It will end on the 25th of August. It is now the 3rd of June. So we’re bearing in on the half-way mark. In the time since the preps started, I’ve done about 4 weeks of prep-mode studying. The rest of the time has been spent in an exhausted, depressed haze where I got heartily sick of the books and was just feeling like crap. On the days when I worked, I worked hard. I clocked in about 8-10 hours a day of pure, hard concentrated study. However about 10 days of a week of such study, I’d break down for a week or so and do nothing but mope around and feel sorry for myself, wondering why I lost the spark of competitiveness that once defined my personality, wondering why I was such a loser, and wondering other things from my large assortment of imaginative ways to beat myself up.

I was smart though, and I started my preps earlier than most of the class. I had gotten around to not having to take my last clinical rotation and used that time to study instead. Clock 2 more weeks due to that time. That makes a total of 6 weeks of hard study. Considering that the preps are in their 9th week so far, that’s not bad going. I know many people much, much worse off.

I haven’t studied much at all these last 2 weeks. I got sick of studying (yet again) and just stopped. I finally freaked out and decided to start this blog, as a sort of public self-commitment statement.

Writing all this stuff out so far has cleared my head and helped to get things into perspective. Whereas only a few days ago I thought I was suffering from a total disinterest in my field, writing my tribulations out has just made it clear that I suffer only from the exhaustion that all students with so great a work-load feel from time to time. I let my doubts over my profession feed my exhaustion, and for a while, I was seriously considering leaving medicine after this exam!! Talk about escapism! Talk about running away from your troubles! God, I sure did lose it there for a while, didn’t I?

Wow, so far I’ve written 3,000 words on my second blog post. Have I got something to say, or have I got something to say?

  More on an introduction

The nature of the blog.

Why am I so enamored with the idea of blogging down my feelings, troubles, thoughts and struggles?

Hmmmm…I guess when I write down how I feel about something it sort of clears my head. I get to put all the cards out on the table and take a look at them – from a distance as it were. Then there is the actual process of putting the writing up on the web, on a public domain where anyone who cares to can read it. It doesn’t matter much to me if anyone reads them …. Weeell, I guess I do want an audience, such is the pathetic nature of my egoismJ; but I’d be cool if for a long while, no one came and read my posts. As long as I know I’ve made pubic my confessions; my attempts to rid myself of my weaknesses. Just having it out there seems to be good enough for my purposes as of now.

Thursday, June 02, 2005
  Me own blog.
Okay then, since this is the first blog entry, it is befitting if a major portion of the post here is dedicated to explaining why I’ve decided to keep one. Before we get into that however, a brief introduction is in order.

First off, I’m not going to ever entirely reveal who I am. I’ll share lots of detail, but I don’t believe I’ll ever sign my name here. I’m not unknown in the circles I move around in and I don’t want people who know me personally to come here and read the stuff I have to say. I might be complaining about them (in some future blog) and it would be awkward having to face them after I’ve ranted on for a good 500 words about how evil they are.

I am a senior medical student in Peshawar, Pakistan. In about 4 and a half months, I’ll be done with my final exams, and by about December 2005, I’ll have graduated and be Dr. Pak (my pseudonym, of course). In about January 2006, I’ll start studying for my USMLE exams – which are the exams one needs to take in order to practice/train as a doctor in the US. The USMLE process will take a long time, and no doubt, will be a difficult time for me.

Currently, I’m on my “preps”. Where I come from, “preps” or preparatory leave is time you get off from school to study for the final exam. In the stupid medical college I go to, there is no semester system (no internal assessments, no mid-terms, no quizzes, papers, assignments, etc…) and while that may seem like a really great way to get through school (basically months and months of wasting time, not studying and then freaking out during the preps!) its not! Final year, the year I’m in right now is considered to be the most difficult year of all. We have the following subjects to contend with:

And we’ve got to learn the entire contents of the course for one, very long, one and a half month-long exam. It’s a very stressful, dispiriting time - I can tell you from personal experience. One senior described it as a “mentally crushing” exam.

More on that later.

Oh, and I’m a 25 year old male.

This blog is an attempt to better myself. I noticed an extraordinary degree of openness in some of the blogs I’ve read over the net. (There was a great reason why I got into blog-hunting [medically related blogs, that is] in the first place...more on that later…where was I, yes!...improving myself.) I feel if I lay it all out, post it up on the great big bulletin-board of cyberspace, I am somehow going through the process of exorcizing my demons. Maybe I’ll find a group of friend and well-wishers along the way who’ll help me out in the re-education/deconstruction/rebuilding/whateverayacallit of DrPak

Hmmm…that’ll do for the very first post.

Recent med school graduate from Peshawar, Pakistan. Started blogging when in throes of final year exams. Currently studying for USMLE Step 1. Aiming for the 2008 Match. I blog about my studies, my worries, and my thoughts on life. I live in Islamabad.

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