Procrastination nation

I think I've cracked my problem with doing homework. It's work.

Also, like, Biochemistry is hard, dude. OMG LOL.!!!1!

But more than that, it's that I was too-concerned about doing well. As the prof said in the intro lecture, this class is composed entirely of people who have a reason to take Biochem. That is to say, the kids who make up the bottom two-thirds of every normal class are simply not here. 70% is a B here, and nobody who would get less than a C stays around. In other words, it's med school.

And I had been all worked up about how this means the end of my quiet life, and now I have to get all Type A and perfectionist. Weirdly, my slackerish tendencies derive from my desire to be perfect at everything, all the time, instead of a lack of caring. I struggle with something, I find it takes longer than I think it should, and I get all surly. And I don't like being like that. So, the internal logic goes, if I can't grasp the subtleties of alpha helices and binding regions quickly enough, then I'm screwed. I don't want to snap at people, so I may as well just put away the work that's making me feel bad and go play Lego Star Wars for another hour.

Except here's the thing: I need a C or better to pass the class, and proceed to grad school. I need a C or better in each of my classes, while in school. And as I'm fond of saying, I'm a PA student. I'm done competing with the other kids. If I'm learning, and if I'm putting together the pieces of my medical education in a way that helps me and my patients, then I'm doing fine. It's not about being the first in my class, or in the top 10%; it's about becoming the best damn clinician I can be. So I will do the rest of a chapter today, and I'll take the first of the practice tests. And if I get 70%, I'm going to relax and keep going the way I have been.

All I have to do now is enforce that policy with myself. We'll see.

The Heartbreak

"My disease." I hate that phrase. Stupid, imprecise, makes all kinds of assumptions. Just the opposite of what medical language is supposed to be. But I'm talking about my disease today, something I rarely do.

Eight years ago, at the end of undergrad, I discovered that my health coverage had a charming clause that capped not only my out-of-pocket pharmacy expenses, but the amount the plan would pay. I had used it up, because the topical gunk that dealt with my psoriatic lesions (we call 'em "spots" in the trade) happened to be this awesome synthetic vitamin D-3 analogue. Sunshine plus beeswax. Not available in generic, then or now. Sorry, kid, I was told, you're too sick to be covered anymore. So I did my best; I got by with OTC products for a few months, until I had a bad flare-up. Big lesions. Spots on my face, and up to then I almost never had spots on my face for more than a few days in winter. Cracks and fissures. Scales, peeling, crumbs in the bed that were totally unrelated to food. Dragonfly wings all over the house. All very Singing Detective. Desperate, maddening, and absurd.

And I called up my derm at the time, the man who would eventually semi-quasi-not-really retire to Mayo Scottsdale, the elder statesman who would later encourage me to go into medicine myself. This is a man who has a talent for saying simple things at just the moment I have become ready to hear them. He got me hooked up, I don't even remember with what, or how. Maybe it was after I started working at the dot-com, and the founder/CEO (another of my statesmen) started my benefits a month early. The derm-doc affirmed what I had been doing, and got me in for an office visit. Overbooked me, I think, if I remember right. When I said something dim about not wanting to inconvenience him, he said "yes... but you're suffering."

Hm. Hadn't thought of it like that.

Chronic illness is part war, part marriage. You want to fight, but if that's going to be worth anything, the fight can't be everything. You want to live with the situation, but without simply surrendering a whole corner of your life to it. You need to decide for yourself (and you can renegotiate anytime) whether the goal is to eradicate the offending nastiness from your life, or just get through to next month with a decent quality of life and not too much stress. Even the most battle-hardened, treatment-aggressive patient will, if he is paying attention, discover that being "sick" has something to teach. Even the most yielding, Buddha-like survivor knows that living with something is different from curling up in a ball and giving up (particularly if that sort of "living with it" means hitching your star to a poorly-defined symptom complex and a stack of presriptions). But yeah, this definitely sucked. I guess I was in fact suffering from psoriasis, at least at that point.

That was eight years ago. Since then, a rotating combination of cool pharmaceuticals kept me out of that kind of trouble. Since 2004, I've been on Enbrel, which rocks so hard I'll write a post about it alone. I love this recombinant human protein molecule so much, I would totally marry it.

I ran out in July. I have more coming, very soon. I've been off for about 6 or 8 weeks. Today I went to the Urgent Care, and they punted me to the ED. To my workplace. It's bad again. It will be okay, more okay than last time, and sooner. But yeah, it's bad today.

I'll talk more soon, because right now, more than 4 of 10 pain or unending static in my nervous system from itching, I am just too annoyed to blog. I don't like suffering. Particularly my own.

Late nights and antibiotics

I've been quiet lately, because I've been having issues with my giant, swollen, reddened pinna.

That's the outside part of my ear, you degenerates. It's just a matter of time before exposure to MRSA and GRSA and whatever-else-RSA fells us ER warriors. Happens a few times a year, maybe. Usually it's a cold; no big deal. I have an immune system just a tetch less powerful than Wolverine's anyhow. But this time, I must have touched my ear with some bug hitching a ride. Stoopid itchy ears. Tuesday after work I spiked a mild fever, and Wednesday I actually called in sick, with all-over aches and a craving for fistfuls of ibuprofen. By yesterday I was mending but not yet better, so I got the Urgent Care experience.

This will be another topic for another post; it was cool that they recognized me there, and I totally got the VIP version. Land speed record for managed care. But anyway, I have Augmentin tablets that are large enough to kill stuff just by running into it, and I'm back to work. Huzzah.

And, in grad school news, I submitted my app. Funny enough, I thought of the line from the first good Star Wars movie, where Luke talks about "transmitting (his) application to the Academy." That's pretty much what you do. So, the deadlines and the editing? The worrying and fine-tuning? Over with. Now it's out of my hands.

I'll enjoy it, when the flesh-eating bacteria gets out of my system and both my ears are the same size again.

In Which I Am Visited by My Old Friend, Sleep Disturbance

Funny dreams, lately.

There was the one where my program director was leading a few of us up a rickety old wooden staircase, like the one in Vertigo. She was happy and social, which matches well to the reality of who she is as a person, but poorly to her persona (we decided long ago it's more fun, and somehow more emotionally accurate, if her persona is about calling us fat and making us cry). There was something at the top of the stairs she wanted me to see. And of course, I woke up before we got to the top.

(I have a theory that the brain can actually work backwards in dreams, and then rearrange the narrative in memory, sort of like the retina sees an upside-down image, but that's a tangent. It does, however, explain some things.)

Last night, I worked until I lost my mental sharpness; then I puttered around until I felt tired; then I puttered a little more until I thought I was physically wiped enough to sleep.

hah.

But then again, when I thought it must be 2, it was 4:15. So it was a good night. But the good REM sleep doesn't hit me until it's just about alarm time. This morning, I had a poignant and sad little dream. It was even in black and white, which my brain uses for mood purposes.

Somebody I haven't talked to in a while had, in the dream, died. Not right then; she'd been dead for a while. But in Gaimanesque fashion, it wasn't a big deal. We spoke on the phone every now and then. But since I had to change phones after I dropped mine in down a storm drain during winter break, I didn't have her number (in... death-land I guess) in my phone. And I couldn't find the slip of paper which held it. You can't just look that stuff up, y'know?

And so I got to go through the frantic-looking phase, then the coming-to-terms with having lost the thing phase, and finally the acceptance that those days are gone phase. All before waking up.

Which in some ways is really refreshing. But I did just email some people I haven't touched base with in a while. Message received! Thank you, Messrs. Hypothalamus and Brainstem!