Chapters 21 and 22: Skiing, and The second year, falling apart

Chapter 21: Skiing

              Around half-way through second year of medical school, I got into skiing. I mainly wanted to start so that I had a winter activity that I could do with my brother. He was an incredible snowboarder and had learned in High school and became incredibly proficient during college. He looked like he was having an incredible amount of fun doing, and so I wanted to give it a shot as well, and maybe it could become something we did together. Spokane has one of the largest Ski Swap sales in the US (discounted older skis). I went with my classmate Ryan, who was going to help me buy everything. I buy a pair of intermediate Dynastar skis outright. I want something I could grow into as I improved. I bought some downhill boots, a helmet, and poles. I had already gotten some ski clothes from the goodwill for cheap. Later I bought the discount pass to Schweitzer mountain in Idaho. I was determined to love skiing no matter what happened. All-in-all, I probably spent a little over $200 of medical school loans to start skiing. After buying everything I was incredibly excited for the winter. Later I met some of the incoming first year class—Aaron, Courtney, Mitchell, Luke—We became fast friends and hung out often. I was almost disappointed that I wasn’t one class behind because we bonded so quickly. They were all skiers. I told them that I was going to learn that year and had already bought everything. They were excited to bring me up to the mountain and wanted to teach me.

              A few weeks later it was time for the ski season to start. I ride up to the mountain with Aaron, Courtney, and Mitchell. Beforehand I watch several YouTube videos online about how to ski. We get to the mountain. I start on the easy green sloope with the other beginners and it goes fairly well. I’m able to pick up speed and turn fairly well without falling, although I have difficulty learning to stop. After a few runs I meet back up with my group. They tell me they think I’m ready for more and bring me up to the main blue (intermediate) run of the mountain. I’m excited but a little terrified. I start skiing down and then start screaming “how do I stop?? I don’t know how to stop?” They laugh a bit, and say just fall over if I really need to. We somehow make it down the bottom of the run. I feel like it’s gone fairly well. I have to fall down to stop. We get back on the lift. This time they inform me that we’ll take a little different run, and that they’ve buried beers along the run and that if I get to those sections I can drink the beers. Aaron tells me that everyone skis better with beer. I agree. It seems like a fun scavenger hunt. We start the next run. It’s rocky for me, I fall and roll down a steeper part of the hill. Then I come to a Rainier beer. I drink it and I’m filled with placebo-courage. Courney and Aaron point to a small jump in front of me. “There’s a beer on the other side, it’s yours if you go off the jump!” I’m nervous but I do it. I land the jump rather flat, and then something incredible happens: I shift my weight to the side and am able to stop quickly for the first time. My friends follow-up the rear and grab the beer and hand it to me. I finish the second beer. We continue to ski. I feel looser and more confident and weirdly in more control. I focus on just relaxing my feet and weight onto my skis and shifting my weight and edges slightly to turn. It’s incredibly fun. I yell out “I love skiing!” my friends are happy to hear it. We get to the bottom of the more difficult run. They tell me good work. We lap the blue chair a couple more times and I practice with my turns, speed, and stopping. I’m starting to feel very confident on skis. Before we end the day they bring me to the top of a Black Diamond run (expert) and inform me that, of course, a beer is at the bottom. I agree to do the run. It’s incredibly difficult. I fall and roll multiple times before making it to the bottom. Then I take my reward. And that’s the end of the ski day. We go to the lodge and get some food before getting ready to head out. Courtney and Aaron tell me that they are incredibly impressed with how fast I learned how to ski, that they have never seen someone learn so fast. Their words give me a great deal of confidence and I thank them. All I want to do now is ski. It was one of the most fun days I had in my life, I believe. From now on I was a dedicated skier and would go as often as possible. Aaron and Courtney become some of my best friends, who visit me frequently in Utah, where we ski, but also who took the time to come visit after my diagnosis and keep me company. They are both incredible people who will make up some of the most fantastic Doctors in America.

              We ski almost every weekend. I look forward to it every time. I continue to make quick progress and soon am skiing double-black diamond runs and other off-piste (unmarked) runs with trees and cliffs. After each ski day I watch or read more about technique in order to get better. The second year of medical school is turning into one of the best times of my life. I know that when I decide on residency after medical school, there will need to be skiing available for me to be happy. It was a huge shift of priorities.  Later that year I ski with my brother and his friends. They are shocked that I had only learned to ski that year. I’m grateful for the compliment. It’s fun and I can mostly keep up with a few difficulties along the way. I know my limits and be sure to take an easier route when needed.

              Now the dark clouds were rolling in. It was time to start studying for Step 1, the large board medical examination that may become the most important test of my life. Our dedicated study period was from January through mid-March. I was worried that now I wouldn’t be able to ski as much after just getting into it.

Chapter 22: The second year, falling apart

              Near the end of second year of medical school I had a mental breakdown. After a college morning I utterly failed to present the patient that I had interviewed. I felt like an absolute failure, and I felt like, “shouldn’t I be improving?” and so if I were getting worse now was this just the start of a new trend? Was I going to burn-out and become a terrible doctor? Afterwards Denise sat down and talked with me about what happened. I shared with her all of my uncertainties. I told her that I knew I had the knowledge to do it, but there was something about the process that just wasn’t clicking. She had seen my test scores and she agreed. That’s when I first shared that I thought I was becoming depressed and burnt-out. Denise told me that that was a very normal occurrence in medical school. I was shocked to hear this, if it was so common why didn’t we do more to prevent it? Then she showed me how to access the counseling resources. I thanked her. I told her that I thought things would get better. She asked me to keep in touch about how everything was going, and to let her know if if it wasn’t improving. The next day I went to the Gonzaga counseling office and got an appointment with a psychologist. They asked me if I had a preference on gender. I told them no. They told me that it’s important you connect with your psychologist and that I could always switch if I didn’t think the fit was right. I didn’t like knowing that. Like, if I were a psychologist and someone wanted to switch, did that mean I was bad at my job?

              My appointment was the next day. I showed up and was initially asked to fill out some surveys about past psych history, any suicide attempts, hospitalizations, medications, and if currently I was thinking of harming or killing myself. I answered no to everything. It felt quite impersonal. I thought that maybe if some of these things were true, it would have been better if someone had asked me about it in person. Then it was time to start my appointment. The psychologist was a kind-appearing older gentleman wearing a large brown sweater. He was balding and had a medium-sized full beard. I sat down in a comfortable leather chair across a small wooden table from him. He had a leather-bound notebook in front of him and was holding a pen. He started with an open ended question. He asked me what was concerning me most, essentially why I had come in. Briefly, I explained how I felt like I was slipping a bit in medical school and that this was incredibly frightening, and then I shared that I felt like I was having difficulty connecting with people in general. I felt like everyone had interesting stories that brought people together and that I didn’t have these same things. He asked me if I thought it could all be related. I told him yes, that I thought maybe socially and emotionally I had not yet grown enough to become a doctor and that these things were evident in my social life as well. He told me I had good insight, and then we began to discuss strategies to face this predicament. He gave me some exercises related to the medicine work so that I could reflect more on my interaction with patients. He also suggested that I try to go to open-mic or story nights and try to tell my own stories and gave me a list of resources related to that. We talked some more, I received some more exercises in general. He asked when I wanted to come back. I told him I would try these things and I could come back in a week. It was a plan. I was grateful to feel like I had a plan and resources to tackle this issue, and I was excited to get to work. Entering medical school I was hoping to grow as a whole person—intellectually, emotionally, spiritually—and I felt like now I was really making progress toward some of those latter elements. I felt like by the end of medical school I should be the absolute best version of myself that could ever exist. Yes, it was a lofty goal.

              Over the next few days I used the tools and techniques the psychologist had given me after my time with patients and even sometimes after social situations. I did not do any open mic nights, I was a little to timid for that, but I did practice telling more stories to the friends I had made in the class. I chose some of my Japan experiences because they were easy to talk about. And overall it went well. I felt like I was making progress, and that I was becoming more comfortable with myself. The next week I went back to the psychologist and we talked about how my week went. I told him about what I had done and that I felt I was making good progress. He told me he was proud of that, and that he really liked working with medical students because they actually went out and tried to make progress. Next we discussed models of behavior and thought so I could better understand intellectually what the goal of what we were doing was, and how we were trying to effect change. I thanked him. I would continue to do the same things as before. He asked when I wanted to come back. I told him that things seemed to be going well, and that I could just come back if needed. He thought that this was a good idea. And so I effectively graduated counseling. I felt better, and I started to do better in medical school again.

….

It was time for the big slog at the end of second year of medical school: studying for STEP 1, perhaps the most important test of any of our lives ever. Most people studied independently. I made a study plan for myself to cover all of First Aid, and to review all of the high yield material. Elizabeth and I shared our plans and checked in periodically to see how each other were doing. We decided on the same test date, which I was glad for because it made me feel like I had a teammate in an otherwise lonely process. Every morning I woke up, made coffee, took a practice exam. Then I reviewed the practice exam and the relevant material for anything I got incorrect. Then I would start with the book study on raw material, about half-way through I would take my pharmacy flashcards and go outside on a walk, just to break up the day a little. After book study, it was time for a quick break and some food, then I would take another practice exam and then review it, along with the questions I missed on the one in the morning. It was the highest concentration of knowledge attainment I had ever had before. Part of it was exciting as I witnessed my knowledge-base grow, giving me a little confidence for the test ahead and for my future as a physician. Every weekend I took one day off and skied, usually with Courtney and Aaron. It was the perfect break from studying—one whole day to recuperate. And at the same time I got to witness my skiing quickly improve. It was two months of high-yield concentrated self-improvement and I was loving it. Elizabeth and I had a few group study sessions to keep each other sane, and to see how we were doing. After a little while, we decide to move up our test date and take the thing early. The practice exams are going well and we’re both becoming incredibly stressed. Our test date is moved up a few weeks. Then it’s the day of the test. We go to the center. I’m happy to have a friend and a familiar face with me for the day. They give us lockers to store our stuff. They go through all of the rules and how the test will work, and what to do if your computer stops function, etc. I’m beginning to get nervous, and I’m shaking from all of the coffee I chugged just before starting. We put our stuff away and are led into the room. The test starts. It’s difficult, but feels just like the practice tests. I can feel my anxiety subside slightly. I take one lunch break half-way through at which time I have another coffee. Elizabeth and I finish at nearly the same time. We’re so revealed to be done, but terrified that we may not have done well. We leave the building, talk about several of the questions, decide that we both probably did alright, congratulate each other, and then go back home. We are going to go out for drinks that night to celebrate. After getting home we go out to the bar. We’re both exhausted. We don’t have the energy to truly celebrate. We each have one beer, say we’re tired, and then go home and call it a night. I’m grateful to be done, and it feels like my world has opened up again knowing that there is nothing I need to do the following morning. I’m on a vacation now. Later in the week I would fly to Japan for my little vacation. I decided that I would go ski the next morning. I felt free. In the back of my mind I knew that third year, the most important year of medical school, would begin soon. I didn’t feel prepared, but right now I needed a break so I decided not to try and prepare for that yet.