The 4 days of inactivity stretched out to 6. I tried on the fifth and sixth day to try and get something done, but just couldn't. I went over some of my previous posts during this time and was reminded of the whole carbohydrate thing - in that eating a carb-rich meal before going to sleep makes me sleepy. I self-analysed and realised that I was doing just that these days; eating carb-rich dinners then going to sleep. When I'd wake up the next morning, I'd feel really woozy and couldn't get much done.
Of course, this is not to say that my diet alone was the reason for my inactivity. There's also a healthy dose of laziness and fed-upness to consider. During this time, as I was moping and feeling depressed, I realized a bunch of things. I wish I had written them down at the time, it would have been useful to write about some of them in detail for future reference.
One thing was that 'nothing succeeds like success'. These last few years, I've met with repeated failures in exams and every failure has been a huge blow to my self-confidence and has always ushered a long, painful bout of self-doubt. I kept thinking I was worthless, useless, stupid, lazy, unreliable etc...
People are only as competent as their achievements define them to be. If for example, a medical student has a father, mother, and two slightly older siblings as doctors, then he would be in an excellent position to be guided into the profession and through his education. No less than four people in his household, all willing to help, could deal with any doubts, frustrations or misconceptions. I know a person in just that position. He went on to great things and I was wistfully thinking the other day that I wish I were as disciplined as he was in my work. The truth is, I never met him, I just knew of him, and I sure as hell knew nothing about his discipline or work ethic. It occurred to me that having two parents and two siblings who were successful doctors and students had more to do with his success than his discipline. He would be guided step-by-step along his journey through med school. If he found a particular topic very difficult to understand, he could draw strength when he went to his father who assured him that that topic is indeed quite complicated and that confusion in it is only to be expected.
'All right then,' the son thinks, 'its not just me then.' And he'll go back to the books with that comfort, saving any self-doubt or disquiet.
If another med student goes to a great school, where he's got great teachers and helpful seniors to see him through, then that, more than his discipline or work ethic will determine his success.
And if these two guys succeed in their profession, score well in the USMLEs and go on to great residencies, then it doesn’t mean that they are somehow inherently more capable than someone like, say, me. People may be keenly studying the aforementioned individuals, looking at their study habits, their sleeping habits, their outlook on life, their hobbies…. Their lives will be analyzed to bits as people use them to try and derive a formula. But the question must be asked, just how much of these individual’s success is due to their own inner character and how much is environmental If the student without a whole family for doctors did not have that, would he still go on to do as well? If the student in a great university did not have his university, would he still do as well? And if they didn’t, who would ask them for advice on success?
Once you succeed at something, it seems as if you must have all the answers and worked out all the angles. You must be doing something the rest of us aren’t. You’ve got bragging rights then. You can strut around dispensing advice and looking down at people who don’t do as well - thinking that they’re lazy, they’re inept, they’re not worthy of your respect.
To a great extent, our successes must be shaped by our environment and our influences. I know a doctor (who’s done really well for himself) who turned his life around when he was exposed to the right people – ethical, hard-working doctors who were good human beings as well. The influence of another person might make the biggest difference.
Of course, the need for self-analysis after repeated failures is necessary. But when this analysis is finally interpreted to the conclusion that you, because of your failures are somehow less of a person than Dr. Perfect over there, that’s when your insides fill up with dark thoughts. You start hating yourself for no good reason and look up to people who might otherwise be the biggest jerks on earth if they didn’t have things going for them just then.
Of course, this leads us to the conclusion that there can’t therefore be an objective indicator for what one needs to succeed. That’s a little disturbing but not, I think, as disturbing as the belief that whatever that ‘objective indicator’ it is, you don’t have it.
I have’nt worked for 4 days now. I feel scared. I’ve got 35 days till the papers start and I’ve got a lot of work to do. All this analyzing, all the intellectualizing I’ve been doing, in the end it comes down to a simple thing really: I’m a lazy person. I don’t want to be in the difficult situation that I’m in. I’d rather be up in the skies as a writer, or want to develop ‘ridiculously enthusiastic’ philosophies of life.
Once a friend of mine approached two respected seniors whom I happened to be sitting with at the time. This friend was some 2 weeks away from the Step 1 exam he had been studying for over a year and a half for. He sat down with us and told the two seniors that he was not giving the exam. He said he was having severe anxiety attacks and he didn’t think he was ready to give the exam. He was going to pull out and give it next year (this chap was giving the Step 1 while in final year and he told us he now wanted to give it after the final year exam). The two seniors spent some three hours talking to him, trying to boost his morale, encourage him, to tell him he’s just panicking unnecessarily etc.. etc… In the end, he changed his mind (although he changed it back, and then back again – he finally gave the exam 2 months later than originally intended and got a 92). One of the seniors, tired from the effort of talking so much said with a grin that they should have used Pakistani psychological techniques from the very beginning: get a big stick and beat him till he came to his senses. I laughed a lot.
But he’s right in a way. In this difficult field that I’m in, there is no easy way out. There is no way one can breeze through these difficult exams feeling wonderful and peaceful and safe all the time. These big exams bleed you. They take away your self-confidence, inject cold fear into you, making you doubt yourselve, and make you think you’ll fail.
There’s no easy way out of this. I’ve got to plow through the rest of the time I have and just work screw the psychology, screw the efforts at maintaining my sanity. I’ve got to bleed. I think I had it right a few posts ago. I have to bleed for my bread.
Maybe I’m feeling so messed up and so pessimistic because I haven’t worked for a number of days. The main reason for that is my insomnia (at least that's the excuse I keep using). I would wake up two hours after going to bed, unable to sleep, and while in the beginning, the “ridiculous enthusiasm” saw me through and got me through the day, eventually the lack of sleep caught up to me and I spent the whole day extremely sleepy despite drinking dangerously large quantities of coffee. To counter this, last night I went to bed early, determined to get my full 8 hours this time, so as not to have excuses. I woke up two hours after going to bed, unable to go back to sleep. Rather than ‘mistake’ this for enthusiasm (which I definitely wasn’t feeling) I decided to get up and have a bite to eat; that might get me sleepy. Sure enough, an hour later I fell asleep again and I went on to sleep another 5 hours. Seven hours total. That should be enough to ward off any sleepiness for the day. I’ve got to learn to respect my mind and body. If it needs sleep, I’ve got to give put it to bed. Otherwise I’ll just waste the following day very drowsy. I need to adopt a more sober approach to studies. This isn't magic, afterall.
Let’s hope the morale picks up by the end of the day.
Its been more than 2 days since I’ve done a significant amount of work. I didn’t study today or yesterday and the day before just clocked in about 3 hours before tiring out. Today, I felt really really tired. I was incredibly sleeply throughout the day. Ironically, when I had decided the day was a waste and quit worrying about it, which was sometime in the evening, I stopped feeling sleepy.
The greatest feeling in the world is when your hypermotivated to accomplish a difficult task and go about doing so with unbridled alacrity. You breath, eat and sleep your ambition and you feel the world is just a stage that plays out your destiny. There’s nothing like that feeling. Despite the insomnia it causes, despite the stomach acidity, its worth it.
For me, the thrill here is knowing that if I do the USMLEs in 10 months I’ll be saving a year and going to the states far sooner than I ever previously would have considered feasible. Before, the USMLEs seemed to be an enormous undertaken that had to be approached with months of rest, no small degree of trepidation, and lots of praying muttered along an uncertain road. It just seemed like such a huge deal. Almost like planning to have a baby!
To reduce it to a year-long roller coaster ride is a novel concept to me. 10 months on Step 1 and Step 2 CK. Another month in
I feel thrilled to think that the end of my student days can potentially come quickly. After the Steps, my days of cataloguing the number of hours spent studying, and lamenting that those hours never seem to extend to double digits will be over. There’ll be no more poring over books with the same sense of urgency. I feel thrilled that I may be making this exciting journey soon. Getting my stuff packed up before I leave, landing in the US for the very first time, making my own observations of that place, traveling thousands of miles inside the US as I go to different places to attend the interviews, seeing old friends who’re settled there… and finally landing that residency position! Once the studying is over and all that’s left is traveling and interviews, the process seems exotic and immense fun.
I seem to have lost that ‘fire in my belly’ over the last few days. I’ve reduced my sleeping hours down to 5 hours, and although that sets me up for an epic battle against fatigue, I have to learn to get by on that much. The ‘family problem’ that upset me for a couple of days has been resolved, and when it was, I felt the enthusiasm returning. I woke up fresh at after sleeping for just 2 hours. I immediately started thinking of getting some work done.
I need to keep that enthusiasm going. It overcomes fatigue, it brushes uncertainty aside, and it provides the energy to forge ahead with ‘almost ridiculous enthusiasm’. If my stomach acidity, which had also waned these last two days with my enthusiasm is a measure of how hyped I am at any given moment, then I guess right now I’m back to being hyped. The acidity is back which comforts me a little.
I’ve got to visualize the rewards - always keep them in mind and use them as the fuel. Indeed if all fear of failure were kicked out of my psyche and replaced by an eagerness to work towards my dreams, then life would seem to be full of promise and excitement. I want to hang on to the hope that the state of mind I was in just a couple of days ago is mine for the taking and not a quirk. I need to just pack up my fears and anxieties, kick them out, throw caution to the wind and forge ahead in the belief that success is only a matter of time.
I'm full of energy. It seems like my perspective on life has completely changed. When I think of the "very very blue" entry I wrote, it seems like it was a long time ago. But it's only been 4 days! So much seems to have changed in the last three days. I'm energetic and enthusiatic about life. Like I wrote last time, I feel like a teenager: forging ahead with the blindly positive unethusiasm that only youth can manage. Studying has really picked up, and today I found myself aiming ever higher.
I didn't sleep last night at all. I worked through the whole morning, and went to sleep at to wake up 4 hours later, feeling fresh and eager to study. I then went back to sleep at , and after just an hour, woke up feeling fresh and eager again. I'm going to go and study now, in what I'm sure will be great day!
What's going on?? How did I get this way? Is someone slipping something in my coffee?
Whatever it is, in my present state of euphoria, I believe it will last. I can barely hear the vestigial pessimist in me that tries to speak up and tell me that it won't last. The last three days, I've slept an average of 4 hours. The days seem so much longer to me now. I have 40 days left for the exam, and right now, that seems to be enough time to get everything in my schedule done.
Life is good.
The acidity was really bad in the morning, so I took some raniditine. That seems to have done the trick. My gastric pH is behaving itself now and leaving me be. I have insomnia, for the second night in a row. I went to bed 2 hours ago, couldn't sleep, so I got up to check my mail and stuff.
I'm all worked up over the possibility of successfully doing my USMLEs after my final exams. It just seems like such a real prospect. The adrenaline rush that comes with the Step 1 exam is already coursing through me, and that's giving me insomnia. I didn't study that much today. That was partly due to the insomnia of last night, partly my acidity, and partly because I was reading this USMLE guide written by Aga Khan students. It's an amazing guide; its into second edition and it deals with all aspects of the USMLEs... from how to apply for the exams to how to dress for the interviews. It's an amazing effort by those extraordinary guys (actually the majority of the writers were girls) in AKU. Hats off to them.
Reading the guide, which took a few hours, I got all pumped up again because the writers repeatedly referred to the fact that delaying your Step 2 CK exam all the way till September is not necessarily the kiss of death. In fact, the primary author of the first edition gave her Step 2 in October. Knowing that I've got that much room to breath in is comforting. I was getting all tense and nervous about having to give the exam in July or forgetting the whole thing. Of course, they recommend that the Step 2 CK be done ASAP so the application can be that much stronger, but do say that giving it later will not preclude participation in the upcoming match. I'll still be aiming for July, but it's comforting to know that I've got some room to move around in.
I feel a little thrilled and anxious at the same time. Such an important time is coming up. Lets hope it ends well.
Why didn't I work? Well, I got sick and tired of books. The dumb thing is I had only been going some 7 solid days before I slumped forwards and walked away from the books. I regard that as a huge sign of weakness. When considering that I'm thinking of taking my Steps in the 10 months after final year, I not doing well at all. It’s a really bad sign that I can't lug it out for more than 7 days before throwing in the towel.
For a while, I thought that this incident proved once and for all that I am incapable of the discipline and effort required to get those very high scores needed for the USMLE. After all, maybe I just don't have the inner strength. Maybe I'm weak.
But then I thought that if I were to give this wonderful dream up on the first sign of trouble, then that there was the real weakness I needed to be worried about. I told my uncle (who is very close to me) and my brother about my USMLE plans. They both agreed it was a formidable challenge. But this is an achieveable dream.
Studying hard for long periods of time is difficult. It’s a chore. Medicine takes all the enthusiasm you have for learning, picks it up tenderly between it's giant thumb and forefinger, and raises it up to let it drop in it's giant hungry mouth. No contest. The only weapon you have to defeat it is to go into the fight without the expectation that your natural enthusiasm for learning will carry the day. Like shit it will. The only hope you have is the strategy of attrition. You chip away at that giant, not expecting to make great strides in one day, but being content to go forth 10 steps a day when you know you've got 10,000 to go.
Of course, all of this I discovered long ago. It’s nothing new. But I’m only now starting to realize that the pendulum is really swinging the other way. Waaaaay away. It’s no long about realizing that studying medicine is no fun, it’s now about realizing that succeeding in studying medicine is related to how much mental anguish you can bear.
You just need to have to be ready for you happiness and peace of mind to take a beating. If you want to study so hard for so long, don't come in expecting to find some way of maintaining your happiness. Park it outside the door. Try not to forget it on your way out.
Somewhere in my mind, which never sleeps, I thought that I should avoid putting myself in a difficult situation. Studying medicine that way I am doing is a difficult situation. I could intellectualize till I get an ulcer trying to find an easier route around my problems to get to my goals, but I'm coming to realise that the path ahead is just thorny and difficult. There is nothing I can do - no amount of planning or thinking - that will change the fact that those medical books have to be read and learnt by heart. There's a lot of memorization to do, lots of boring repetition, and there is nothing I can do to change that.
I think even my daydreams of writing (all my troubles away) are part of trying to find some peace of mind when there was really none there to be had in my situation. I have a powerful urge to amount to something great, and when I see that goal slipping, I dash over to my writing dream to make myself feel better. While there’s nothing wrong with wanting to feel better, I’m coming to the realization that my success is based less on my intelligence, my resources and my planning, and more on how much happiness and peace of mind I am willing to sacrifice for it. Plain and simple. Suffer thou depression, self-doubt, anxiety, and ye shall inherit the earth.
I'll walk into my study room tomorrow expecting a rough time, and I'll divert my inner resources to build up my resistance to it. I just have to raise my threshold for how much heartsickness and depression I can take.
Sounds simple enough.
There’s nothing like that first cup of coffee that starts off your day. I’ve just finished it, and on the back of a good night’s sleep, I feel wonderful and energetic.
Last night, I was feeling like crap. I was depressed, I hated myself, and I was a little scared. I just felt like crap. I only studied for some 7 hours yesterday, and I was beginning to think that maybe I don’t have that extra oomph needed to reach for the skies. What I need is 12 hours a day, everyday for a long, long time. People do it; hell, I’ve done it for prolong periods of time. I should be able to produce the same magic again.
My goals are very important to me, as is the particular girl I mentioned earlier. I want to get far. I want my mind and body to cooperate with me. Get with the program, like. Yesterday I was feeling a little sick. I think I got hypotensive. I’ve been drinking gallons of coffee, and that remains my number 1 source of water, which I suppose is not quite healthy as coffee is a diuretic. So I downed some 3 liters of water over several hours to treat my suspected dehydration, took some vitamins and went to sleep for 8 hours. Like I said, after the first coffee, I’m feeling fresh and gearing to go. I just hope the rest of the day goes well.
I can’t afford to panic and get despondent because I’m behind on my targets. I need to think positively and quell down the urge to throw my hands up, yell an obscenity and storm out of the study room. I need to remind myself that everyone in our class is having a hard time, not just me.
Let’s hope today works out.
I studied for just 7 hours yesterday. I’m feeling cranky and irritable right now, as I always do when things aren’t going my way. Grrrrr!
I hate the thought that there may be something my peers can do, which I can’t. I mean it really gets my goat. I know several people who do study upto 12 hours a day these days. It really pisses me off to think that there is a weakness in me preventing me from going to that level. Sometimes I feel I am capable of such great things, and the only thing standing in my way is mustering up the will to work hard enough to realize that greatness.
In times as stressful as these, I tend to get brief flashbacks of childhood ‘warmth’. By that, I’m talking about those periods of intense, undiluted happiness that only children can have. I remember a time when I didn’t have to worry so much about things, when life was so much simpler, when I was enthusiastic about things. I don’t get the same intensity of feeling – its more like I remember what that was like. Like seeing a favorite shirt of yours but not putting it on.
I resolved last night, when going grumpily to bed to start studying as soon as possible after getting up. My mind and body are refreshed and it’ll be good to get those first 4-5 hours of work out of the way ASAP so I’ll have more room to breath later on in the day. I just woke up 40 minutes ago. I’m finishing my cup of coffee, then I’ll get going. Hope I meet my targets.
The last few days have lasted the longest time and the shortest time, if that makes any sense. On one hand, I’m at my desk working for what seems like interminable hours, and on the other hand I look at the calendar and see it’s already the 5th of July. Gulp!
I’ve been working an average of 9 hours a day since I last posted. This is still short of the 12 hours a day I aspire for every time I sit down at the start of the day. Most of this time is spent in active memorization and little in just reading the text passively (which is far easier). One thing that has made a huge, huge difference in my morale is my use of the Kaplan Lectures for the USMLE Step 2 exam. This covers half of the subjects that I need to do for the final year exam, and it does so very very well. These lectures DVDs are so far relatively undiscovered in my region. They were only introduced in the country for the very first time a year ago, and then too, only a few folks had them. Over the last 4-5 months, more medical books stores have gotten their hands on them and I believe it will only be a matter of time when these lectures become the one and only source of USMLE study material. The lectures actively teach you the subject matter using a book series called Kaplan Lecture Notes. These notes have been available here for a couple of years. But, like I said, it was only a few months ago that the actual lectures to these notes surfaced as well. Mark my words, in the next year or so, you’ll see USMLE hopefuls coming into the library with laptops to go through the DVDs. They’ll prop the lectures notes next to their laptops, listen carefully to the lecture, and nod along with the words as the jolt down a sentence of two by the sides of the books.
When something is actively explained to you, when the most common mistakes students make in such-and-such topic is highlighted, when they go out of their way to tell you not to forget this and that, or to ignore learning that particular detail - it really becomes a lot easier. Of course, none of that really applies to my own final year exam, which in sophistication is to that USMLE what picture-by-numbers is to the Mona Lisa. However, the material they explain is the same and it’s all relevant. I’ve been going much faster through the topics than I normally do because it’s all explained, and the notes are already written down in front of me to be memorized to perfection.
I wrote earlier about a career in writing, a rather long post in fact. I said that I’d rather be a writer than a doctor. The truth of the matter is that I’d rather be independent sooner rather than later. That’s what the whole writing thing is about. There is a reason to that also. It involves a girl, and marriage, but there is no need to delve into. Going over these Kaplan videos, and seeing how much easier life is when they spoon-feed you instead of you have to open 3 fat books to understand a certain concept is a great morale booster. I’ve been working hectically these last three days on the basis of another plan altogether.
My final year exam will finish in the first week of October. Now, in order to be participate in the 2007 match, I need to finish both Step 1 and Step 2 CK by July of 2006. That means I’ll have, from October, 10 months to do both Steps. Now, no one had ever gone right out of final year (in my college) and straight onto the Steps without missing a beat. The reason to that is in the last 7-8 years (i.e., in the collective memory of the people there) the final year exam has always finished in November or December, which meant there were only 7 months till July to finish both Steps. It would be impossible to do both steps in just 7 months. Our class on the other hand is free in October, which is the earliest anyone can remember it being done (they’ve actually been bringing the exam 2 weeks forward every year for the last 4-5 years. Next year the exam will finish in September). So our class, for the first time has 10 months till July, which is the very last date you should be giving your Step 2 CK exam. Now previously, I would have thought that 10 months were not enough for both Step 1 and Step 2 CK. However, with the Kaplan DVDs…..
Around the first of July, I realized that in the next few years, more and more people will decide to jump on the USMLE band-wagon as soon as they are done with Final year. Not only will they have more time (with the exam ending 2 weeks earlier every year till they reach June - where the administration would ultimately like the final year exam to end), but the Kaplan DVDs will become a phenomenon. I realized that my class is at the very cusp of a trend I’m sure will emerge in the next few years. My class is at a very touch-and-go position. 10 months may just barely be enough time to do both Steps and score well. But I’m talking about skin of the teeth stuff. I mean, there’s no slack room in such a time-table at all.
My final year exam ends on the 4th of October. If I start studying on the 10th of October, I could give the Step 1 six months later on the 10th of April. If I take five days of rest thereafter, I’ll start studying on the 15th of April for the Step 2 CK, and can give it on the 31st of July, three and a half months later. That will allow me to participate in the 2007 match and start a residency, if all goes well in July 2007.
It’s a workable plan. It’s very touch and go, but that’s the only flaw to it. Three and a half months is actually how much time many people take for the Step 2 CK. And 7-8 months is how much time people take for the Step 1. However, all these averages were before the Kaplan videos were ever there. So it should be possible to do this.
But can I do it? That’s a totally different story. I decided then, also around the 1st of July, that I’d use this final year as a trial run. If I can study 12-13 hours a day and be able to sustain that pace for the next 2-3 months, then there is no reason to think I wouldn’t be able to do the steps in the 10 months time-frame.
That’s why I’ve been studying a lot these last 3-4 days. I clocked in 11 hours the other day, but only 8 hours yesterday. I have to start reaching my target of 12-13 hours a day from now on. If I can’t, then I’ve got to let go of the 10-month USMLE plan. Then I’ll also have to forget about a certain girl until I do finally do the Steps.
Let’s see how the next few days pan out. I’ll keep you posted.