a young pakistani doctor blogs...
Saturday, April 29, 2006
I’m feeling depressed. I didn’t study much yesterday, getting caught up a few things at home. I went to bed feeling miserable, but woke up early and got to work. I had barely gotten moving when a friend of mine from Peshawar came to the house for a visit. I like this guy a lot and it was great to see him again. He wanted to stay for some 3-4 hours, but I had to tell him I have work to do and it would be inconvenient for me. He seemed disappointed and I felt like a jerk because he had come to Islamabad mostly just to visit me. He left after two hours, and then my father called me to his study. He wanted to talk about my older brother’s marriage. My parents made a lot of mistakes raising my older two siblings. It’s too long a story to get into now, suffice to say that the conversation just ended up depressing me. He then also discussed my own marriage and expressed his concern that the mehr my fiancé’s family asked for might be too much for him and asked me what he should do if that happens. We had this conversation before several times and every time it ended up upsetting me. They just remind me what a backward and ignorant culture I was born in.
  Lock them up!
I was coming back from my jog today when I chanced upon my mother walking back with my two nephews from a trip to a nearby park. I walked back with them to the house. The younger nephew, M, is 4 years old now. I missed most of his first two years, bogged down as I was in a particularly difficult period in med school at the time, but saw him a lot of him in the last two years, when my visits back home were somewhat more frequent. Both my nephews are great, and I have a lot of fun with them. Although the older one, S, who is 6 is a lot sweeter, more outgoing, and generally happier a child, it is M whose company I enjoy most. He’s very moody, instantly breaking into a wail when he doesn’t get his way and keeping his sonata going for astonishingly long periods of time, oblivious to the world around him. Rarely, he throws genuine tantrums but mostly he just cries obstinately, although the sound is never annoying.

Today, when I was walking them back home, M would run about 30 feet ahead of us on the sidewalk. I was watching him nervously all the time, thinking of a million and one ways he might get hurt. Someone could screech up in a car and whisk him away. He could bump into someone on the sidewalk. Worst case scenario, he could veer off the sidewalk and start running obliviously towards the road. Past experience has demonstrated that both my nephews are much too smart to do anything so careless, but nevertheless, I kept watching nervously. When it was time to cross the road, I held S’s hand and told him to hold M’s hand so we could cross together. I waited for a break in the traffic and as I saw one, started walking forward with them. M didn’t walk however, but started running and was soon leading me and S. I had started walking before a car had fully passed by us, because I didn’t know if we would get a cleaner break in traffic than that. The car still hadn’t passed us completely and M got about 10 feet of it, scaring the bejeebers out of me. The car passed and we crossed the road safely to get to the separator between the two roads. There was another road to cross, and after the scare I had already gotten, M looked frighteningly chirpy and impulsive, still forging ahead of us. I told him to stop running but he wouldn’t and before he got near the second road, I let out an Almighty yell telling him to stop right now. He froze in his tracks and looked back. I took his hand and made sure the second crossing was much safer than the first. Only when they were finally back home did I relax completely. My mother, who has raised not only four sons, but also many of her younger siblings didn’t bat an eyelid. I envied her conviction that the kids could safely run around in the open outside the house. If I had my way, I’d lock them up inside the house all day and never let them out.
Friday, April 28, 2006
My work is moving along well. My energy levels are quite high these days, something I attribute to a bout of jogging I did a few days ago. I discontinued the jogging because I had a cold and didn’t feel like running with a runny nose and scratch throat. I’ll start again tomorrow.

The sense of urgency and purpose has returned. I have to say, part of my return to form was due to admitting my study problems to Aya, who then proceeded to give me a proper dressing down and gave me some sound advice on how to overcome them. I took her advice and it worked out quite well. One nugget was disconnecting my internet connection in the mornings. I’ve admitted it before; that I’m quite the net junkie, spending hours clicking away like a zombie before realizing how much time I’ve wasted. Getting some 4-5 hours of work done in my morning session gives me a great boost and the momentum sees me through in my evening session.
Saturday, April 22, 2006
  On Life
I went jogging today in the afternoon. I was feeling really lousy and depressed before the jog, but when I came back my mood elevated markedly and I felt a lot better. Note to self: be regular at exercise, it’ll stop you from wanting to kill yourself.

Life is full of ups and downs. How many times have I felt that it might be better if I weren’t born at all? How many times have I felt happy to be alive and thankful to God? How many times have I wished I were living in some monastery, far away from this life and all the things that make me unhappy and unsure of myself? I have felt ecstatic, happy, blessed. I’ve felt miserable, suicidal, cursed. Sometimes it’s seems all so futile. We go through all these emotions, these colossal vicissitudes of life – we try hard to make something of ourselves. One problem or crisis resolves itself in our lives and another soon follows. There is really no end, no objective that needs to be fulfilled for us to attain happiness. Perhaps life is all about finding happiness in the tragedy of our lives.
  Feeling lousy
Yesterday was another crappy day. I felt inexplicably tired all day. Maybe it’s because I have stopped jogging and a few liters of blood have now decided to form a lake in my legs. I decided then try to do the whole jogging bit in the morning, as opposed to the late afternoon. So I woke up today at 7am and quickly washed up, put on my joggers and went out by 7:30. Outside, it dawned on me that by 7:30 there is an unpleasantly sharp sun out waiting to pound down on me. Delicate and precious that I am, I decided to turn back home and rustle up some breakfast, another healthy activity.

Soon after, I decided to move the cooler used in my brother’s room to my own room, thereby solving the problem of my broken cooler and allowing me to move back into my room. Of course, this will create a problem for my brother, but I think I have more right to his cooler because I am upstairs more than he is, and more importantly, he’s not here right now to stop me from taking it. I asked a cousin who was visiting us to help me move the coolers. They are situated outside the room, exposed to the elements, supported by metal pedestals and positioned so that the fans blow into the rooms through their windows. It was a dusty, dirty job and I felt really tired afterwards, which might be the allergy, I don’t know.

I think I’ve really got to get my butt off this chair and start jogging again regularly. Morning jogs won’t work because the sun will only come out earlier with every passing day and I don’t see myself jogging at 6 am to beat a hot sun come june/july. I think I’ll have to stick with the late afternoon jogs. I hope that will go someway towards upping my energy levels. Feeling tired all the time is lousy.
Friday, April 21, 2006
  Crappy day
Yesterday was a pretty crappy day. My brand-new room cooler, which was doing a great job until now, decided to go into retirement. My room is on the top floor and I’m separated from the roof only by the ceiling. The roof, unfortunately is smear with deep-black tar and soaks up the heat during the time the sun is out so that around noon, the heat starts radiating down from the ceiling in waves and my room actually becomes warmer than the outside. I’m going to have the roof painted white, because even with a functional room cooler, it makes no sense to have such grossly inefficient thermodynamics to contend with.

I was forced to shift all my stuff and hijack the adjacent room, my father’s study room, in which there’s an air-conditioner. The AC works great, but the room is small and cramped, and I’d be glad to move back to my own room. My parents are out of town, so the room is all mine for now. The problem of the room cooler will be fixed when they return because everybody knows I’m too precious and special to indulge in such menial tasks as returning a broken room cooler.  

My allergy returned last evening. I had stopped taking loratadine after a few days because I thought I’d be over the allergy by then. The stuff is not really as non-sedating as they say, although perhaps I’m being over-sensitive on that score because I’m always looking to have a really clear mind when I’m studying. I can easily bypass the problem by taking the stuff at night, which is what I did last night.

Lets hope today is a better day. Full of tons of studying, no allergies, and the cool, soothing hum of the air-conditioner.
Tuesday, April 18, 2006
The other day I rearranged the furniture in my room. It took a long time because I also had to clean the mess I made while moving the stuff around. For a day afterwards, I had a stuffed nose, irritable eyes and a general ‘I don’t feel so good’ feeling. I realized that I might be having an allergic reaction to all the dust that was thrown up during the process of fixing up my room. I went to the drug store to get a non-sedating anti-histamine (loratadine) and I’ve since felt a lot better.

I realized retrospectively that I had been suffering from a mild allergy for a few weeks now. I sometimes needed an inhaler and a nasal decongestant spray to get to sleep comfortably because my airways felt ‘tighter’ around the time I got to bed. I didn’t think much of this at the time, thinking that I was just being fastidious, but with the loratadine the breathing problem vanished and I woke up today feeling fresher and more alert than I had felt in a while. The allergy had been draining me of strength and even though I resorted to an inhaler and a decongestant at night, it never occurred to me to think I might have an allergy.

It’s strange how doctors loose their objectivity when it comes to their own health.

On another note, while writing this entry my Orange Card for the Step 1 exam arrived along with an orientation CD. I’ll formally schedule the test date soon.
Saturday, April 15, 2006
  Here comes the sun.
I called my fiancé last night and we agreed on a new timetable. Step 1 will be on the 15th of August 2006, and Step 2 will be on the 15th of January 2007. My fiancé works about three times harder than I do, and I trust her judgment. I felt much relieved after the plan was formalized and this morning I woke up with a familiar urgency (no, not the urinary kind) getting down to work fairly quickly. I worked steadily throughout the morning, my enthusiasm slowly returning. It’s shaping up to be the end of this dark cloud I’ve been carrying around with me for the last few weeks. I feel vaguely excited at the prospect of the challenge that lies ahead and am starting to believe that everything will, at the end of the day, ‘be arright’.
Friday, April 14, 2006
My fiancé’s orange card has arrived and mine is one the way. I’m going to call her tomorrow and we’re going to decide on an exact date for our Step 1 as well as discuss exactly what we want to do after our steps. We’ll agree to a new, well-thought-out plan, draw up a good schedule, and stick to it.

On another note. Aya is also on her way back from Pakistan. It’s ironic that when she came here (to attend a wedding) we almost lost touch completely and it’s only when she returns to the US that we’ll be able to communicate via GoogleTalk regularly. I’m glad she’s “coming back”.

Tomorrow I hope things change for the better. I’ll get cracking with the books early, try to wade through as much material as I can in the morning session because by late afternoon I’ve always slowed down considerably.  
Thursday, April 13, 2006
  I think, I think
I think I’m honest enough with myself to realize that my decision to delay the exam is also a result of my own terrible study habits and my terribly low stamina for studying. 8-9 hours a day would be a very good day for me. Unfortunately, they have not been very common these last few months. There are also days when I just can’t bring myself to study at all. I make up some excuse and tell myself I can’t study much today, or if I don’t have an excuse, I promise myself that ‘from tomorrow’ I’ll be a new man; that I’ll change.

For quite a long time, I’ve externalized my shortcomings. Yes, I thought I was a horrible person for not reaching the goals I had set for myself. Yes, I was evil, and useless, and lazy, and unreliable. However I always thought that if circumstances had been different, then maybe I might be different too. If I had gone to a better college, I would be motivated to work harder. If I had friends for support (when I was in Peshawar), if this happened or if that was possible. However, the motivation to excel should be independent of external circumstances. My life might be crap, but that doesn’t mean I should wait till it gets better to have the will to work my ass off. I kept blaming my lack of motivation on external factors and although I hated myself for never working hard enough, at the back of my mind, I always had an ‘excuse’.

My younger brother, who is an academic giant, spent one year at home. He had finished his A-levels and taken his SATs and wanted to apply to universities in the US. He had the grades required to get a scholarship. Indeed, he had a full scholarship from LUMS which he turned down so that he can redo his SATs and score amazingly in them. For one year, he was stuck at home, with no friends to call on, no social life to speak of, just studying for his SATs, and learning C+. I thought it was a terribly depressing way to live one’s life, but he persisted and scored a 1540 in his SAT I (to his immense disappointment, as he was aiming for a 1600). He didn’t get a full scholarship to any of the Ivy League schools in the US, so the next year he won the LUMS scholarship again and went to Lahore, where he excelled there. This January, he started working in Microsoft.

If I was stuck at home (not a very pleasant prospect, believe me) I would feel depressed and sorry for myself. I’d moan about what a miserable life I had and that depression would definitely impact on my studies. Rather than make the most of the situation, I’d look at all the negatives and let that bog me down.

Recently I’ve come to realize that I’ve got some really bad habits. I also realize I’ve really got to stop externalizing my problems. If I think that a place or a situation is somehow ‘draining’ me of the motivation and discipline I need to study, I’ve got a big problem right there. I’ve also believed in the past that if I was always regular in my prayers, in reading the Quran, etc… that this would give me the ‘center’ and balance I needed to discipline myself in studies. This too is another way if externalizing the problem. I shouldn’t rely on God to change me, or help me change. I have to make my own decisions in life and I can’t pray hard and long, asking God to do things for me. This again, was an externalization of the problem. I was not relying on my inner faculties to overcome my study problems. I was not relying on my own sense of discipline and work ethic, I was relying on prayer to make me all better again on the inside, and that in turn would then help me in my studies.

The source of my study problems lie within me, not in the outside world. I’ve got to change my own way of thinking and looking at my world, and not try to change my world. If I’m not studying right, I’ve got to look no further than myself to get to the root of the problem. Its not just study problems that result from my tendency to externalize my problems- it’s just that study problems are the most obvious manifestation of this weakness of mine. I’ve got massive flaws in my personality. I’ve done things I’m not proud of, and I never seem to want to look into myself for the answers. It’s always the environment I’m in thats at fault. If only circumstances were different…

I don’t know if I’ll ever get to solve this dilemma of mine. For too long now, I’ve been plagued by the insecurity that comes with unfulfilled potential. I know I have it in me to reach for the stars. No matter how badly I’ve done in the past and how much I’ve disappointed myself, I never doubted my God-given ability. If I don’t do well in life and don’t achieve my goals, it will be because I didn’t fight to overcome these bad habits of mine, always blaming my environment for my grades rather than looking for the cause in myself.

The first step to redrawing my inner circuitry is recognizing the problem. I hope this post is one step forward in what will undoubtedly be a long journey. I also hope it isn’t followed by two steps backwards later on.
Wednesday, April 12, 2006
  I'm back
I think I said once on the blog that if I’m not writing for a length of time, it usually means things are not going well and indeed this has been the case during this long absence.

Around the middle of March, I slowly came to the realization that I’m not going to make it for the 2007 match. To make 2007, I’d have to finish both Step 1 and Step 2 CK by September at the latest. I talked this over with Aya and Moiz and a few other friends. They all initially encouraged me to give it a try, so for about another week I tried working some 12 hours a day, which is what I needed to do to make 2007. However, I failed miserably and, discouraged, decided to forgo the 2007 match. I talked it over with my fiancé, who also said she didn’t feel ready enough to make it for 2007. Since then I’ve mostly been amotivated, feeling like crap and wondering what I’ll do in the year 2007, after my steps.

I’m tied into the Steps along with my fiancé. We are both planning to match together someplace and so we can’t really afford not to do well in the Steps. I felt that if we both got low 90s/high 80s, it might be trickier to match together in a good hospital than if we both got high 90s. This has always been a consideration and it was what forced the decision to let go of 2007. If I were going it alone, and a double match was not mandatory, I would have gone ahead and been happy with whatever score I got, using it to get into whatever program I could. However couple matching is no joke and the couple trying to match in the same place must be in a really good position when they apply, otherwise if they don’t match in the same hospital, or the same city, one will have to give up a year and gamble their career on getting a match in the same city the next year.

It has been difficult giving up on 2007 and abandoning a plan that had been in my mind for the better part of a year. After these steps, I will get married, and not having a good job is also somewhat of a concern. I hope we can both get paid house jobs somewhere in Islamabad, otherwise being married with no money at all does not seem like a great prospect to me. It’s definitely something that needs to be sorted out, but for now I’ve got to put it on the backburner, redraw my study plans and find it in me to pursue them with some motivation. The prospect of making the 2007 match was a huge motivating factor for me because I wanted to be independent and this was a great way to go about it. I don’t have that motivation anymore and it’s been tough to muster the same sort of interest in the books that I used to have. I’ve lost a considerable amount of steam and my study has gone down the toilet as a result.

As always, when I’m not doing something productive with myself I feel like trash. My self-esteem has not been at enviable levels these last couple of weeks. However here I am, putting in a blog entry, so something must be up.

Nothing is ‘up’ really, it’s just that I’m finally learning to live with my decision, and am feeling hopeful for the future. Knowing that you’re not going to be starting your residency anytime soon has been difficult to swallow and as weak and pathetic as I am, it’s taken some time for me to adjust to the new reality of the situation. I’ve decided on a date in August now, and am aiming for a 99, and am hopeful that I will get it, as will my fiancé. After we score brilliantly on our steps, we’ll start a house job together in Islamabad. I’ll work very hard and hone my clinical and diagnostic skills during the house job and do my best to publish something to boost my CV. I’ll go to the US around May next year to give my Step 2 CS exam so that I’ll be fully certified when ERAS opens in September and so I can give Step 3 as soon as I go back for the interviews in October. It’s a plan, and I’m learning to feel more and more good about it.
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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