This journey started at one of the low points in my life. I failed. I nearly lost everything that mattered, but somehow survived and was able to create this amazing opportunity from the ashes. 

Several years before any of this even started, I read The Alchemist, by Paulo Coelho. This book is a modern allegory that follows the journey of a young shepherd on his way to finding amazing treasure. Throughout the book he loses everything but gains so much more than he lost. 

Sometimes, I feel we get stuck where we are simply because we're afraid of losing what we have. When in reality, we aren't fully satisfied with what we have but we've settled out of fear. We tell ourselves this is good enough because we are too afraid to go after what we really want. 

In my case, I needed a little help from the universe to push myself into chasing after what I really wanted. So, after losing my job, almost losing my life and my loved ones, I realized that I was being given another chance. A chance to start over and do whatever I wanted to do - I just needed to figure out it was. 

That's another thing that holds us back. We are full of endless possibility and worlds of perseverance but lack direction. The old adage of "You can do whatever you put your mind to" chafes against us because we lack a "whatever" to actually put our minds to. This was, for me, by far the harder thing to overcome. 

It was not a meticulous and logical rationalize that got me to where I am - it was almost a whim. My heart told me to go answer the question of "what if...". I literally received some sort of lightening bolt thought into my brain one morning that told me - Hey. Go to Med School. It was October 14, 2010. 

From there I began investigating if that was a real possibility, and what it would take to actually accomplish. Along the way I learned that this career path held real hope for me - the satisfaction of everything I'd ever been seeking in a career, in a life, in a dream. 

It was easy in the beginning - Beginner's Luck they call it - and the road rose up to meet me, ushering me along the way, as if you could sense the very excitement in the air. As I get closer, it gets harder. It asks more of me, and demands that I redefine how I will continue along the path. You have what it takes - but it will take all you've got. 

So now we come to this place where the journey continues, but the terrain is about to change. I am finishing my coursework, I am studying for the MCAT, I am preparing to apply. And I am so very thankful that these chances are mine to explore. This has been the most frustrating and challenging things I have ever attempted to accomplish. And once it's accomplished, it starts a whole new journey of difficult navigations that will also demand everything I have to give. 

However. I am beyond convinced that this is the road I want to take. I know without any doubt that this is the career I want to have. And its not just because I've sacrificed everything to get here or because I've been following it so long I can't conceive of another way - it's because my heart is in the journey with me. This may not be the scientific answer I'm expected to give when asked why I've chosen this direction. It may not make logical sense or fit nicely into an AMCAS response, but it is the reason I can keep going. 

Endless joy. For me this journey has consisted of both unmatched frustrations and unequaled joy. These simple tasks with which I am entrusted may be humble, but they give me a sense of satisfaction at the end of the day. I am not maximizing profits or workflows, I am maximizing human experience. I am easing the suffering of individuals, if only for a moment. And in the end, when there is nothing more that can be done, I am taking a few precious moments to prepare things for their next step - with respect for the life that has just ended, and compassion for the family that is left behind. 

There is nothing more I can ask of the universe, and no greater tasks which I will hope to accomplish. These next few steps in the journey are simply the things that I must do to continue doing what I love. They are the obstacles along my path, and with both my heart and my mind committed to the goals, they don't stand a chance of stopping my forward progression. 

It is often said that to reinvent ourselves, we must destroy ourselves first. I truly believe that for me this was the case. The journey ahead is full of unknowns and difficult roads - but there is a pathway through it if only I would follow my heart and my mind - my compasses leading me on. In the end, I don't really believe in fatalism, but I do believe that there are certain things which will bring you great joy based upon what you find satisfying and what you are capable of. For me, the marriage of these two things is the treasure. For me, my genes, my experience, my talents, my abilities, have all written a code for me - a possible future that will bring me the greatest joy possible. That... to me... is what it means when I say... 

It is written. 

I transferred out of transport and into an oncology ward as a nursing assistant in October. I really wanted to have more meaningful patient interaction experiences. And it's been nice to actually interact with people for longer than ten minutes, and to actually have a chance to watch their case progress through its stages.

Cancer is a disease of a healthy population. That seems counterintuitive, but its true. Without considering childhood cancers caused by inherited genetic instability, cancer can only invade a population that is healthy enough to live long enough to acquire it. Millions of base pairs get replicated each day, some incorrectly, and these genetic mutations sometimes go unfixed. Unfixed and persistent genetic mutations eventually lead to other genetic mutations, which eventually mutate something required to keep cell growth in check, and boom, unregulated cell growth. Cancer.

I work in a stem cell transplant unit. Some of the very sickest people come to my ward. Those who are about to receive a transplant, those who have just received one, and those dealing with the complications from one. Despite our best efforts, survival rates for cancer as a disease class have not significantly improved since the "War on Cancer" was declared in the 1960's. Sure, there are some cancers that have excellent survival rates and that, for all intents and purposes, we really can just "fix," but these are the exception rather than the norm.

I hate to be all depressing, and I'm sorry I'm not citing my work, but the main point of this post is not to discuss cancer, but to discuss clinical detachment. That magical protective barrier that clinicians build around themselves in order to be able to do a good job for their patients without becoming emotionally involved.

I arrived on the ward after one of the ward favorites had just passed away. I don't think I ever even met her, except perhaps in passing. The next person who died was someone who arrived back on the ward after a brief stay in a nursing home. I was witness to her "code" and saw the flurry of activity that accompanies calling a code. I think I passed out barrier gowns and tried to stay out of the way. Se didn't pass that day, but sometime later, surrounded by her family. I did not cry or get upset.

There have been several people who have passed while I've been here, no one who was directly under my care at the time, but people that I helped care for, people whose names I knew. I felt detached from them and their situations. I certainly felt that their situation was unfortunate, but it wasn't my situation, and cancer, after all, is kind of a bitch.

But that emotional fortress I thought I was so cleverly hidden behind has cracks. I am not a stone, and I do sometimes become emotionally involved. The patient whose situation had me crying on the drive home last night is thankfully still with us today, although the case is complicated. There's a really wonderful spouse, there's an army of grandchildren, there's a whole life that occurred before this moment, before the word cancer changed a lot of things.

It wasn't the tears of the patient. It wasn't the pressure ulcers. It wasn't the sight of the grandkids even, really. I think it was the tears of the spouse. The patient is in pain. The patient is not perfectly lucid. The patient is asking the spouse to let them go, let them die. The spouse starts to cry. The aide at the bedside, usually so reserved, usually so much better at doing what must be necessary without emotion, is crying as well.

But vitals must be taken. Blood sugars recorded. Daily intakes and outputs collected. The ward must be rounded on. I cannot dally too long, but regardless of where else I went that night, I was still in that room, holding the patient's hand, getting the spouse blankets and pillows as the spouse prepared to stay the night.

I think it's harder when you see that someone loves them. We all assume that they have loved ones, but when you see it - day in and day out - the strain of caring for, and I mean really caring for, a sick loved one...the heavy bags under their eyes, the hand holding even while the other one is asleep...that's my weakness. I can too easily imagine myself in their place, can too readily imagine what they must feel.

Death is the final part of life, the inevitable end to this biological moment. For my patients, it is the end of suffering, the end of pain, the end of chemo. But for their loved ones it continues on. Life, suffering, memories. My empathy gets the best of me when it is their pain that I witness, and not the patient's. There is no cure for that, and I cannot help abate it.

Here we go

Well, there went summer. I did not cure cancer. Heck, I'm not even sure I figured out what I intended to figure out, although I did learn a lot. If research taught me anything, it taught me that data contains both interesting positives and pertinent negatives. It also contains "huh, I have no idea what that means." moments.

But that's neither here nor there. Here we're standing at the beginning of my actual senior year. At the end of this school year, I will finally graduate with my undergraduate degree(s). I decided that enough was enough and that I was ready to move on. It's kind of terrifyingly awesome because the next steps are actually rather cool.

I'm taking the MCAT in May. I signed up for a Kaplan course (and managed to negotiate a discount with them for my entire college...woot). I'm taking Physics 1 and Organic 2 with lab this semester. I'm also working in the lab 10 hours a week, participating in student government, shadowing doctors, and trying to find time to do the things I enjoy. I rediscovered some of my hobbies over the summer and decided that they need to be part of my life, regardless of what else is going on.

I also interviewed for and became the "final candidate" for a higher position at the hospital. It has far more patient contact (and actually counts towards patient contact, go figure!) and will give me the opportunity to confront death, dying, and survival in a much more immediate sense.

I am happy. I always wondered what you could do with your life if you didn't spend all your waking hours reading crap on the internet at a job you didn't like. Turns out you can do whatever you want with your life if you get all that time back.

Little chances

So, I'm a huge television junkie, which I think we've already established. This time of year, things are running down to their season/series end, and that means lots of reflective episodes, lots of goodbyes, lots of the ole "take a chance and never look back" message.

I've been thinking about that whole message lately, and how it translates into my life and choices. There aren't any big plane rides that I have to take, any tables of roulette that I need to bet on... in essence, there aren't any lines of demarcation between making the "Big! Giant! Choice!" and the aftermath. For me, it's all a bunch of little chances that might translate into big changes.

The decision to go to med school was not met with a sudden change in my life, although it was toasted with much fanfare and congratulations. It was a big decision, admittedly, but the changes it mitigated were small ones. My class schedule filled up with science and math, my timeline to graduation lengthened, and I added a major to my ever-growing list of credentials.

However, looking at my life this morning, while walking to the lab, I was struck by how different it was from my life two years ago. Two years ago, I drove to a job I couldn't stand, to do work that was uninspiring, for people who didn't appreciate it. My days were an endless recreation of the one before, and while graduation was on the horizon, the changes it would bring would be minuscule to my day-to-day.

I had no idea what was going to happen, or if it did, it would be satisfying and worth all the work I had to go through to bring it into reality. Majoring in public service was something I did because it was easy - the classes were offered at night and on weekends, the subjects were not too challenging, and the work I would eventually be "qualified" to do wasn't that much different from the work I was already doing.

I had a happy life - don't get me wrong - but I didn't realize it at the time. I often felt that something was missing, that I had taken a wrong turn somewhere, and I felt a profound sense of loss for a life unlike the one I was living.

Fast forward to today. I'm about half-way through the pre-requisites for applying to medical school, I'm working on a summer research project funded by the National Institutes of Health, I'm a certified Emergency Medical Technician, and I'm working towards a more patient-centered position at the hospital in which I work.

These changes did not come about overnight or even relatively quickly. They were the conscious effort of many small decisions over a long period of time. I read somewhere that our "...futures are dependent upon today's behaviors and actions." I'm finding that statement to be far more relevant than "take a chance and never look back."

In addition to lengthening the timeline of change, it also lowers the stakes of each choice quite a bit. There are many choices that once made cannot be unmade and that forever change your destiny - but these choices are often the exception, not the rule. It is far more commonplace for there to be a series of choices that actually bring about the change we wish. This gives us a great deal more leeway with individual choices, and allows us to experiment and see how the individual choices impact our environments.

I think my basic point is that it's certainly fun to watch Rachel Berry get on a train and arrive in New York City, her life forever and instantly changed, but it's not very realistic. Alas, it's hard to celebrate the little changes at the moment when a choice is made, but maybe it's better to realize that a long time ago, in a land far away, I once made a choice... and that no matter how small or insignificant it seemed at the time, it set the stage for a whole host of other choices that would eventually bring me to today - and that today is a beautiful thing.

Looking forward

Well, I did it. I survived Ochem 1, and got out with a B+ for my efforts. Ochem 2 is in the fall, but before that, there's a whole summer of no-classes. This is my first summer off in seven years, and I do plan to enjoy myself quite a bit.

I've started looking at schools, it's actually rather enjoyable. Mr. Crazy has endorsed the plan to sail off into the sunset WITH me, which is actually a change from what I expected. So, between the two of us, we've been doing a lot of broad-strokes of rejection to potential schools - too far! too south! too west virginia!

In all seriousness, there's a lot to consider as I narrow down the list. I started by gathering all the schools in the surrounding states, and then knocked out any school more than 300 miles away from the 'burgh. Last October, I made a declaration that Family Crazy does not drive more than 300 miles, because longer than 6 hours in the car is insufferable.

The next thing I did was pull the rankings from the US News page, and start to rank schools into "safety/good shot/long shot" categories. The Student Doctor Network forums gave me another good list of things to consider - required lectures? Hospitals where clinicals are done? Hours spent in lecture? And other such assorted questions to consider.

I'm down to a list of about 22 different schools, spread all across the eastern seaboard, with a giant excel spreadsheet recording notable details. I figure this summer is a good time to narrow down the list, especially considering that I don't have to obsess over anything academic besides research.

Once I made the decision to go, the future has never been uncertain. For me, this is a certainty. But actually starting to think about where this is going to take place has given the dream a certain quality of realness that eclipses all other things I've done so far.

Well, I think my plasmid is done CIP'ing, so, off to purify some DNA...

Abe says I'm supposed to post...

I demand a lot of myself. I work weekends, I have class five days a week, I volunteer, I do research, I serve on student council, I have a husband and a kid. I recently "amped up" the studying too, devoting at least twice as much time to it as I had been. It actually improved my understanding of the material, and certainly made me feel better about organic chemistry.

Anyways. I started working out three days a week too, hoping it would give me more energy. It really did, I am far less tired when I get home (whenever that is) and my physically demanding job actually seems a bit less demanding. Combine that with the fact that my average work day finds me walking 8 miles and pushing 4,000 pounds (yes, I added it up.)

I've been acting like all the kids I'm competing with, yet I am still 34. I had this theory that as long as I ate right, exercised, worked out, got my rest, took my vitamin, that I wouldn't feel the effects, wouldn't actually feel any of those years...

Wrong.

I started having back spasms this past week, walking out of class with my gazillion-pound backpack on my back. (Dude, I even wear the sternal strap and look like a total dork because I'm trying to distribute the weight appropriately.) I saw two chiropractors and my PCP, took a week's worth of steroids for inflammation, got some awesome muscle relaxers (did I mention I love being a grown-up because they FINALLY give you good drugs?), and ... you know... totally didn't take it easy at all. What? You saw that coming.

Anyways. I don't know what my point is. Maybe my point is that the road to med school is hard and made even harder by the fact that the mind is so much more willing than the body. I've decided this latest turn of events means physical therapy and at least once-monthly massages. I've been taking care of my body chemically, getting my cardio, and feeding my brain...but I haven't actually been taking care of all the other stuff that moves me from place to place.

The years come with wisdom and self confidence, but that comes at a price. You can't go all those miles without a little wear and tear and unfortunately, some of mine is starting to show.

*This post was written on a combination of some really sweet drugs. (That were prescribed for the author.)

It was in the afternoon. I'd been volunteering for about two months at this point and had seen all the "basic" calls - diabetic with low blood sugar, shortness of breath, transfers to hospice, chest pains, etc. It was another shortness of breath call and I remember thinking "Another one? When am I going to get to see something good?"

I'm aware that wanting something interesting to happen makes me morbid and inconsiderate. But in my mind, "something interesting" happens all the time anyways, I just wanted to be there when it did.

It was still sunny when we arrived. He had his shirt open, exposing his chest, and looked "sick". Or apparently looked sick, because I didn't notice, and it was only because the medic noticed and later talked about it that I can relate that. Seventeen years on the job will give you those sorts of instincts... I hope to someday have them too.

He only said he couldn't breathe, and then his spouse took over. He'd had recent surgery. She had been at the store and came home to find him complaining of having trouble breathing, so she called us. He passed out almost instantly, and we moved him to the floor. The medic and the other EMT started assisting his respiration. I took over bagging while they did other things.

The medic was trying to intubate and asked for "cricoid"... the other EMT was confused, maybe he didn't hear her correctly. We talked about that two weeks prior in my human physiology class, so I placed two fingers over where I imagined his thyroid was. Later the medic told me she was impressed that someone who'd never been on an arrest call knew what to do. It made me glad I study.

Another medic showed up to provide "Advanced Life Support Backup" (ALS Backup, so they say.) He started an IV. Fluids were pushed. I felt nothing while this was occurring. I was too busy counting to 8 and squeezing the Bag-Valve-Mask (BVM). He was packed up into a Reeves stretcher, and moved to the actual stretcher waiting outside. Somewhere between the house and the rig, he lost his pulse. The medic started chest compressions while everyone else strapped things down and got ready to move.

At some point during the ride, I took over compressions. I still felt nothing, but couldn't stop counting to eight. Just a continuous 8-8-8-8-8, this time with no punctuations of squeezing a bag. His eyes were open, seeing nothing. Emesis was coming out of his mouth, on the outside of the ventilation tube. I did compressions until I needed a break. The other medic took over.

We arrived at the hospital. It could have taken five minutes or an hour, I was unable to account for the passage of time. The medic directed me up onto the rails of the stretcher to continue compressions while we wheeled him into the ER. Later I was informed this was the "glory spot" and was called "riding the rails."

Report was given at bedside. I removed my gloves and washed my hands. I stood in the room and watched the nurses, doctors, and other professionals take over. I became aware of beads of sweat running down my abdomen, inside my uniform shirt. I was not shaken, did not have the jitters, and was not consciously aware of any adrenaline rush. But I could hear, see, and smell everything. I was focused on the task at hand. I felt no emotion.

They recovered his heartbeat at the hospital. We cleaned the rig. While I cannot guarantee how long his heart continued to beat, it was beating when we left. I do not know if he woke up. I don't know what happened next. I know only that I crossed the line that afternoon, from the group of people who've learned CPR and never used it, and into the group of people that have.

I felt unsettled the next morning. Not unhappy. Just unsettled. I couldn't get a grip on how I felt about the experience until several days later.

I feel good. I feel like I was a taught a skill and then trusted enough to be placed into a situation where I needed to use it. The classroom did not prepare me adequately, but does it ever? I got an "A" in my class, and had the top score for the state test. It was not a lack of preparation, but simply that nothing can prepare you for that experience.

I hope to be better prepared next time. I hope to provide better assistance. I need to learn where the leads go for the monitor, and how to set up the capnography apparatus. I don't want to let this whole thing go without examining it and trying to figure out what I need to learn.

What I learned most of all is that I can respond appropriately in an emergency and that my adrenaline rush comes in the form of increased focus and a methodical approach. The world for me slows down, and I with it. I learned... that I chose well for my future profession. That I want to be here, dealing with these issues, and that when I get there, I'll be completely unprepared but totally willing to learn.

(details have been changed in order to mask identity)