Crazy 2 months - school life

So I thought I'd continue my updates with the school/placements.

My Placements
So at the beginning of november I finished my hospital placement, and surprisingly I was actually well-liked for the first time, and appreciated. In fact the strange thing is that everyone on the team accepted me and I actually worked really well with all of them. I was really sad leaving them and my perceptor even gave me a mark of being at entry level practice and with distinction. What was even more remarkable is that I was actually sick for 3/5 weeks and everyday struggled to control my asthma. It wouldn't be surprising for me to constantly wheeze, and be SOB. I learned to hide it well, but sometimes I just couldn't like when I was forced to take the stairs, then I would get noticeable SOB and would have to pretend to do notes to recover. I wasn't sure what it was that I actually had, because mostly all I had was a scratchy throat, no cough or fever, I was sure it was strep and so started antibiotics, but they didn't really help. Eventually with rest whatever it is I had finally was gone and I finally recovered.

I was really lucky because there were only 5-6 patients on this unit, and sometimes we would only have 3 patients for the whole day. So we would see the 5 patients together and thankfully most were ambulatory so it wasn't that physically difficult. Most days, we would start at 10 and finish at 3 with a full hour lunch, and she was actually surprised when I would try to work through my lunch! The patients were interesting since this was an inner city hospital, a few had dementia, a few others had personality/anxiety disorders. The only difficult part of the placement was that it would take me 1.5 hours to get there and another 1.5 hours to get back. I felt at home there, and I even though I can never really imagine working in an acute setting mostly because most of my day involved transfers and ambulation and then writing lots of notes, I really liked the team environment.

My 2nd placement was another story. I knew it was going to be a lot more difficult that my previous one as soon as I saw an email stating that I'll be having 2 instructors in both inpatient and outpatient setting in this case neurological rehabilitation. Considering my previous experience with 2 instructors, I was very very nervous. I can't even begin to describe how vastly different my experience was. Let me first say that this rehab center is a very busy place and they are very understaffed. Every physio is expected to have 10pt on their workload which is crazy considering 8 are neuro patients. A patient only gets 30-45min of therapy/day which is definitely not enough to recover properly and the therapists are very overworked often having no time for lunch and working overtime to finish paperwork. In my opinion, it wasn't fair to add a student into that mess because in that kind of environment it is very difficult to just see all patients let alone try to teach anything to a student.

To add to the craziness, my instructors expectations in general were definitely not the most reasonable, and add in all the stress from my grandmother's fracture and MI and hospital stay and it is a recipe for disaster. Their expectations were that by the end of the placement, I see 7pt/day by myself, which to me is ridiculous, considering that at another neuro facility the PT only sees 6pt and the student would only be expected to see 4, so for me to see double that was completely unfair.

It was definitely a struggle, and I dreaded coming there every day. I did learn how to attempt to improvise, and how to be more assertive ie: attempt to seem like I know what I'm doing. I learned that its important to lower the tone of your voice to seem more in control, and to try to reassure clients daily about their progress.

I realized early on, that I wouldn't be able to do neuro as a job because it is just too physically challenging, and the treatments are very vague. Even by the end, I still was not able to transfer clients properly myself, I managed somehow but I did start to have some back pain, and apparently I was told my legs are too long and in general my knees are too weak (injury) to properly 'lift with the legs'. I wanted to learn how to facilitate gait training, but what I realized is that its a lot tougher than it looks and the treatment varies quite a bit. What works on one person doesn't work on another, and because of different areas of the brain affected by the lesion (stroke), different muscles are weak for different people, and trying to figure out which muscles to activate is very tricky. I was always pressing too lightly or too hard, and often in the wrong place.

I also found it very tough psychologically. How do you tell a person they won't be able to walk on their own? How do you live with the fact that this person is not getting the amount of therapy that they need to get better? How do you explain to the person that they won't be able to go back to living on their own, or going back to their job? We're taught that our job is to get the person to their maximum level of functioning, but is that really good enough? Will this person be satisfied with having to walk with a walker and not being able to work? But in all of those cases, we're expected to swallow our own feelings, and convince the person that they are improving and they have the potential to continue to improve and given their condition they are doing very well....the problem is I know what its like to be on the other side of the coin. I know how hard it is for that person and their family to have their lives completely disrupted and have to adjust to a new condition that affects every aspect of their lives. I often felt like I was lying to them about how well they were doing.

Some days I felt so frustrated and overwhelmed I just thought I would start screaming if one more thing went wrong. Let me paint a picture, there is a small gym about the size of a living room, where there are often 7 clients and 7 therapists, so a total of 14 people, in a tiny space all trying to do assessments and exercises. Now there's me with a general social anxiety and add in some mild ADD, and you have a problem. Not only was I overwhelmed by the number of people in the small space, I felt I couldn't really concentrate because of all the noise and felt the need to often shout to be heard. Often times in the morning when I was in the small gym, I would get a bad headache from all the noise which made it even harder to keep pretending that I know what I'm doing.

In the outpatient part, I felt a lot more comfortable because it was a lot bigger, there was a lot more space and thankfully no need to shout. All the clients that came were comfortable and in control and wanted to improve, I didn't have to keep convincing them to do their exercises to get better. I even had an opportunity to take over my instructor's caseload for 2 days when she was sick, and surprisingly with a few hiccups, I managed to do it. Now, of course, in general I was following the exercise sheet and was unsuccessful when trying to do gait training for a particularly low level patient, but I think everyone more or less felt comfortable with me, and I was trying my best to appear confident and I think I succeded.

Looking back, I felt like a lot of the clients deserved a lot more time than what we had. It is hard, especially if the clients are younger. There were a lot of people in their 50's and some even in their 20's and their lives have just been turned upside down with their stroke or other neurological disorder. The most frustrating for me was when I knew they reached a plateau, and no matter what I tried to do, they couldn't keep improving beyond their limit, and I think that it was even harder for me to accept than for them.

I wish I could say I did well, or improved my performance by the end, and personally I think I did, but alas, for my instructors it wasn't good enough. I kept messing up the paperwork (note in my defense, there was a ton of sheets to fill out and definitely not enough time) even though I kept staying well into my lunch time to finish it (20min lunch). I was messing up some parts of the assessment (parts which we didn't learn about...), and was apparently not showing enough initiative (I hate that word) and interest...ie: I was supposed to figure out how to fill out all the paperwork myself, and had to try to ask more questions (no time..). The more interesting comments were that I did not socialize enough with the staff....which was very interesting given that first off I'm not that social by nature, and secondly I couldn't even remember all the 20 staff members names to actually properly socialize, and often was so overwhelmed by figuring out the paperwork and exercise that needed to be given that socializing was the last thing on my mind.

By the end I was just tired of pretending of appearing fine and happy, and tired of not being able to speak my mind. They said that I needed to ask more questions and communicate with them more, but whenever I tried to be honest they would just criticize me and tell me that I just had to work on the skill more without telling me what I was doing wrong or how to fix it. They said that my personal life shouldn't interfere with my job which I agree with, but everyone's human, and in a real job people can take time off to care for their family. They had no idea how much energy it actually took for me to come to work every day and completely shut out my personal life and appear normal and happy. None of the clients noticed it, and they all appeared satisfied with their care, isn't that what's most important?

I've learned by now to take the good with the bad and go with the flow. I learned a lot, and I myself think I've matured and grown a lot as a therapist. I do wish that it would get easier not harder, and that they would prepare us more in class, but I think that's wishful thinking. I've realized that I won't get along with everyone, and I have to keep going out of my comfort zone to make interactions with others easier because that's the only way to learn. My final lesson, I've learned is that learning never stops, there is no way to learn everything in 2 years of school, we have to continue to research and take more and more courses to be able to offer the best possible treatment for our clients, because in the end that is what its all about.

Crazy 2 months

So its been a whirlwind of 2 months with so many problems that after every day I was just so exhausted I couldn't even begin to start to post. So without further ado...

Family
So my grandfather's pneumonia finally resolved after the terrible cough he had continued for another 3 weeks, and we got a long 10day course of antibiotics, of course when one problem is resolved another emerges. So on Nov 24 my grandmother broke her hip (greater trochanteric fracture) after we're guessing semi-passing out and falling to the floor from low B.P (90/40) at 10pm while she was going for a late night snack (something which we kept telling her not to do...). So began a 3 week nightmare hospital stay....

To give some perspective, before the fall, my grandmother had 3 different B.P meds + was using a nitro puffer 5X/week...so she had major heart problems before everything. So, after a lot of deliberation, we decided to call the Amb. Everybody right away started looking at me and asking if its fractured or not, as if I'm the biggest expert, so from my complete lack of any experience, I did observe it was Externally rotated which is never good, and she couldn't weight bear and was in a lot of pain. I was hoping it was just dislocated, but alas x-ray determined large fracture.... Now the next adventure was actually getting to the hospital, since we wanted a better hospital, and I knew that if I didn't request it they would send us to the crappiest one in the city (already had a few nice visits there), so with the paramedics hint, we said that of course we were there already in the past month....yes the wonders of canadian medicine, you have to lie to get to a better hospital.

Of course the first thing they do in the ER? They give morphine for the pain of course because its not moral for the person to have any pain, what happens in an elderly person with many comorbidies? They go into withdrawl, complete with hallucinations, paranoia...yep, let's just say it didn't start well. We were lucky though since thankfully a bed opened and she was able to get her surgery only a day later. This is where the real problems started....First she had a loss of consciounsness--> ICU visit--> chest pain which I had to battle with nurse to get a little relief with nitro--> back to awful ward where they ignored us and any complaints including continuing chest pain, note my mom was there 24hr/day since my grandma was delirious and doesn't speak english, so needless to say she was exhausted. I was there on weekends and did lose it a couple of times with the nurses and their 'care'. --> MI...after basically 3 days of chest pain where we were giving nitro ourselves, they finally noticed elevated troponin, ST seg depression....and this is only after my mom made up that she was having chest pain for 3 hours and a smart nurse finally took her seriously. Of course being very lucky, they did not have a cath lab at this hospital so they had to send to another hospital and considering this was an 'emergency' she got into the cath lab 1.5 days after the initial dx of the MI and was stented at 11pm at which time she was extremely exhausted and barely keeping it together...very very frustrating.

I wish I could say our nightmare ended, but lucky for us 'protocol' always needed to be followed. So we spent a few days in the telemetry ward, then the ortho ward, and thankfully we were able to actually start going home at night and my mom was actually able to get some sleep. Now at this point, 2 weeks after coming in, she was able to walk short distances with a walker and we really really wanted to take her home...but alas there is the 'protocol' of going to rehab first. So we refused 2 places, even though we were being forced to choose 3 and were warned that we would go home if a spot didn't open in a few days, unfortunately for us a spot did open....

Now to give some perspective this was the same rehab place where I was doing my placement, so I assumed that it would be a good place to recover in...boy was I wrong. So she got place on an ortho unit, which was problematic since her major problem was the heart not the hip, and right away this unit almost completely ignored the MI and heart problems and only focused on the hip fracture. Now because we don't have private insurance and couldn't pay $300/day for a semi-private room, she was placed in a ward suite with 4 beds and 1 shared bathroom, did I mention that one lady was continuously vomiting? My grandma was not feeling well at this point, and we still weren't sure what meds should be used to stabilize her B.P which was still flcutuating madly, so we requested that like at the hospital they help her use a bedpan at night, since she is less stable and more disoriented, and she was using a commode at night. We verbalized this several times, and every time, we were told this is a rehab facility, and that to improve they had a protocol to help their pt walk to the bathroom and they would use their 'judgement' to determine if she needed assistance. Of course they refused to let us stay the night... So on the 2nd day, my mom arrives, to learn that she had a syncope episode after walking to the bathroom and they are sending her to emerg for more tests...oh oh. So my mom goes over to emerg, where they find nothing, except fluctuating B.P. which they can't do anything about until the heart calms down a bit, and send her home...after a 7hr wait for the ambulance to take her back.

At this point we were so frustrated at their lack of any kind of understanding and treatment (she wasn't getting any therapy because she wasn't feeling well) that we thought we wanted to take her home. At this, everyone basically thought we were nuts, and the doc refused, said that she is too unstable (not sure what they were doing to make her more stable), the nurse manager trying to defuse the situation (we were not happy) threatened us that if we leave AMA we will get no homecare, and can't get an ambulance to take her home because our house can burn down and she wouldn't be able to leave! but if we stay until monday she will convince the nice (spineless) doc to release us. Now after the last emerg you would think they would learn that she isn't stable and her fluctuating B.P means that it's prob not a good idea to force her to walk to the bathroom at night for 'therapy'..nope. So we tried to be proactive and explain our concerns to the her nurse about getting her up at night, and the nurse went nuts, started shouting that she has no right to a personal commode since it is a 'public room' and that if she can walk for 100m, she can easily walk to the bathroom.

Well guess what, at 4am the next morning, we get a call that the doc sent her back to the emerg after ANOTHER syncope episode following a walk to the bathroom. We were not happy. At this point we decided enough is enough and we will take her home whatever way we can because she was getting worse and we couldn't take this constant emerg visits every 2 days. So after again everything came back normal, we convinced the ER doc that since she is being 'released on mon' anyway, we want to take her home directly, which the previous ER doc refused. So after another hr wait for the ambulance, we couldn't believe our luck that we finally managed to escape from our medical rehab prison.

You're probably wondering, were we crazy going against the doc and the facility? was the doc right in wanting her to stay (in that awful place) and sending her to ER all the time? Well i think we were right. I won't lie, because she was very far from stable in the beginning, and she did have a couple more scary syncope episodes, and her B.P. did continue to fluctuate, which meant we had to constantly adjust her meds. It also meant that we had to stay with her 24hr/day, and we would take shifts sleeping on a mattress on the floor to make sure we helped her use a bedpan at night. But in the end, we did not once come back to the emerg, and we have been able to after 2 weeks at home get her fairly stable all the while reducing her meds. She is now able to walk on her own, watch tv, and I've started doing the regular hip exercises at home, we have even stopped constantly measuring her B.P, and she hasn't had a syncope episode in 1.5 weeks.

The most likely reason for the syncope? we're guessing it was orthostatic hypotension, which we told them she had before, and in addition a lot of weight loss. She was basically not eating for 3 weeks, because the food was so bad and was actually causing her indigestion.

After all that, we are basically labelled as difficult family members who left AMA and are putting her at 'risk' and are therefore denied home physio and probably more homecare. This experience has def taught us a lot, the most important lesson being to never be afraid to speak up, and that the 'professionals' don't always know best, and sometimes you have to go against the system which can be very frustrating.

Thoughts on my 2 weeks of PT clinicals

So it's been 2 weeks and the experience I've had is thankfully the opposite to my previous experience. The instructor is really nice, explains everything, and often praises me instead of constantly criticizing. It's a different hospital and everyone is much nicer than my previous experience. Also there is an electronic medical system, I can't explain how much I really love it.

Now one reason for this is that it's not as busy and there are not as many patients to see since they are fairly complex. I'm in the internal medicine unit and most of the patients are over 60 and have many complex medical conditions. Most come in for acute problems such as falls, pneumonia, heart failure, inability to cope and polypharmacy causing medical problems. Treating many of these complex patients requires a team effort, and everyone is treated equally and everyone's opinion is respected. This is also different from my last experience, where the opinions of PT/OT/social work was basically ignored.

The PT role in acute internal medicine, is to assess mobility and functioning and recommend mobility aids (cane, walker), as well as progress mobility. So in other words, it involves working on transfers (lie-sit, sit-stand) and walking short distances. We usually start with a person barely able to stand, and slowly with lots of encouragement and support (walker, PT), get them to start walking 20-100m. When they can walk independently for 100m and have no other problems, they usually either are able to go home or go to rehab to further improve their functioning.

We are usually able to see 3-5 patients per day, depending on whether they are medically stable to be walking (normal hemoglobin, no orthostatic hypotension). It is usually not that busy and we spent the last hour or so of the day charting on the patients we've seen.

Now compared to my last placement I get a lot less independence and a lot more support which is really nice. We see all patients together with the instructor, or with the OT. Some might say that by this time I should be more independent, and that I would learn more if I was independent, but the truth is I already had that experience, and it was very stressful, exhausting, and unsafe. Also the patients are elderly, and therefore much more frail which means, walking with these patients often requires 2 people anyway.

Now, in general, this is not the type of setting that I'm interested in working. The scope is fairly limited to working with patients for transfers and ambulation, which I don't feel requires any particularly special knowledge. I am more interested in working in outpatient MSK where we will get to diagnose and treat specific injuries. Also I do not enjoy the hospital at all, and am terrified of catching some disease from the patients such as flu, MRSA, VRE, etc. Now some people will ask, why I chose a HCP career, when I am not willing to work with sick patients with varying diagnoses? My answer is I don't mind working with sick patients, but I do have limitations and fears (ie; not being able to breath in a mask) and therefore will prefer not to work in an acute setting (no jobs anyway) and would prefer a more rehab environment where the patients aren't acutely sick (rehab, outpatient MSK).

Now I seem to always have some sort of problems, and unfortunately during this internship, I am still half sick and have not completely gotten over my previous cold. I am not contagious anymore, but it has presented numerous problems for me. I am constantly wheezing and hyperventilating and have gotten to the point of having an acute asthma attack. Now I do my best to hide these symptoms from everyone, but it doesn't always work well. This is definitely not ideal but I feel like I have no choice as I don't have any sick days I can take to get better, so I just have to hope that my lungs will slowly get better and I won't scare everyone with an actual asthma attack.

So those are my adventures, hope everyone enjoys their weekend!

I hate having to be House...

So in continuation from my previous post, my granfather's strange spells continued and got worse even after stopping the pred and the atropine. The last episode being coughing, shortness of breath, slurred speech, dizziness, and was again relieved by nitroglycerin.

Now I did some more research and realized that stroke is not really relieved by nitro..and the shortness of breath and coughing, as well as symptoms relieved by nitro is more likely to be related to a heart problem, the only thing that didn't add up was the slurred speech....

So a bit more research and what I realized was that the glaucoma eye drops that he was prescribed to decrease his IOP, are actually vasoconstrictors......and in cases where the person has pre-existing heart conditions can cause worsening angina and even heart attacks.....

It finally makes sense, the slurred speech was most likely related to the vasoconstriction of blood vessels in the brain. The drops caused the vasoconstriction which then caused decreased blood flow and decreased oxygen and thereby caused the slurred speech.

In fact, there is a warning to carefully prescribe these drops to people with heart issues. The interesting thing is that most likely all doctors that we go to will deny this and say there is no effect whatsoever, and that something else is causing the symptoms.

So now we are sort of stuck with a dilemma, is the glaucoma a bigger problem than a heart attack?

To most people the answer is simple, since he already doesn't have any vision in his eye anyway and was living with this condition for 3+ years and we've managed to stabilize it, what's the point of treating it right? I mean the reduced IOP is definitely not worth the (higher) risk of a heart attack. Now if only we could find a doctor to whom we could actually explain things to and possibly find a solution...yeah that's a fantasy.

There are other options available such as laser treatment which was fairly effective when it was done the one time, but now we'll need to find a new optho since the old one basically kicked us out. Surgery is another option but there are too many complications.

So now we're back to where we were before, me trying to be House and figure out the causes of the severe symptoms that he's experiencing and whether they could be side effects from the medication and how to manage them. At the same time not having a doctor with whom we can actually figure out what we're supposed to do to decrease his IOP yet not have a heart attack at the same time. Yep I love the medical system.

The type of doctors that make my blood boil

Now I'm not trying to generalize and I know there are good and bad people in every profession (including physio) but, it just seems that more and more meeting good doctors is the exception not the rule and it makes me more frustrated since I then have to play the pretend to be the doctor game.

So, my grandfather is older, has a couple a prexisting heart issues and had a stroke a long time ago, but is otherwise generally healthy (lives independently on his own). Now a few weeks ago, we noticed that his eye got red and swollen, he was complaining of a headache and he couldn't sleep at night. Well we went to the family doc, who spent us to emerg, who then got a referral to optho emerg, diagnosis? severe glaucoma, prob acute angle glaucoma. So the emerg optho (really nice) gave some drops, and sent us on our way to the regular clinic opthalmologist. Here is where the trouble began....

So, let me start by saying my grandfather is not the most cooperative person, and is scared when something is shoved in his eye (no reason whatsoever). So when the optho tried to do anything he would close his eye and become scared. Eventually he managed to do an injection in his eye, and then changed a lot of the drops assigned by the previous optho including adding prednisolone.....anybody see any problems?

Now really there shouldn't have been any real problems, now let me say that at this point, the eye was no longer inflamed and there was no blood in the eye. So we dutifully continued using the prednisolone, and the next appointment after a frustrating session the optho manages to penetrate with a laser and miraculously my grandfather starts seeing out of the corner of his eye. This was fairly miraculous given that he hasn't seen anything for 2 years...

Now it's been 3 weeks, and he continues to take all the 5 different drops including prednisolone (4times/day) and atropine to try to reduce the pressure and the inflammation, and we dutifully continue thinking that the doctor is the expert and we obviously don't know anything.

Then yesterday, abruptly he looses his balance, falls, and starts having slurred speech....you're probably thinking the same thing I am, stroke.

So I think fast, check that he hasn't used his nitro patch today, put 2 patches on him, give him 2 sprays from his nitro bottle, and give 2 aspirins. Thankfully within seconds his speech normalizes and he regain his balance and mobility. Now of course according to standard protocol, we should have called 911 but we have enough experience to know, that in cases of mild TIA the medics and hospitals do nothing except a CT scan which is negative, yes tPA could be used but in general its only used in severe strokes since the risk of bleeding is too high.

So we started investigating what could have caused this interesting and terrifying scenario and I realized my grandmother had a similar scenario after a cataract surgery and was using a lot of eye drops....then we realized that the pred and the atropine aren't supposed to used for such a long time especially if the inflammation has gone......

So we decided to stop using the drops since it's been 3 weeks, there is no inflammation and its obviously doing more harm then good. Now of course, following protocol we're supposed to go talk to the doctor before cancelling meds.....yes of course....well luckily we had a appointment the next day.

Now let me say, this is a busy doctor, really busy, the one who has the 5 minute appointments. So the tech measures the pressure it has dropped, then puts in atropine, he remeasures it..and its high again. We try to explain and ask about our concerns regarding the massive amount of drops he's on, and the risks of using them for such a long time, he disregards those concerns, and tells us that he can't help us since his pressure is still 'high'. Then he tells us he is discharging us from his service and refers us to an eye surgeon.....of course not before telling us that we're idiots, our english is bad, and we don't know anything.

Yes ladies and gentleman, this is a real life account of a highly regarded optho. Now thankfully we have given up a long time ago on trusting doctors for good reason, but hoped that for once we'd be proven wrong.....yeah not going to happen.

I can't even begin to say how many errors this so called optho made, from not cancelling pred which is supposed to be used temporarily, to not understanding the simple fact that atropine raises the IOP and that his measurement was indeed wrong. In addition to completely dismissing all of our concerns and dismissing us from his practice because my grandfather is a supposedly difficult patient, and then recommending a dangerous surgery that is not needed and could cause further complication.

I mean, I get that docs are stressed, overworked, tired, and sometimes make mistakes. But to be this negligent and egotistic is unacceptable, if it wasn't for our quick thinking with the nitro my grandfather could have had permanent brain damage and it shouldn't be up to me to research, understand every medication that is prescribed, their contraindications and then have to decide what meds can be cancelled to prevent more side effects.

There are so many conditions and complications in older adults that can be prevented if docs just thought, is this condition worth treating? Do the risks outweigh the benefits? What kind of counteractions can this med have with all the other meds the person is taking? Should the doses and length of treatment be adjusted for the older adult? What kind of things should the family watch out for?

This and previous negative experiences have unfortunately caused me to never truly trust what docs say and give, since misdiagnosis is quite common, and so is overmedication. I have not once received an honest answer from a doc on the question of 'what kind of side effects should I watch out for' and 'what are the serious side effects from this med'.

Now let me reiterate again, I'm not generalizing and I know there are some really good docs out there that really care about patients and try their best to give them the best possible care, but unfortunately I haven't had a lot of good experiences, and have lost count of the number of times something was misdiagnosed.

Feeling better in some ways, worse in others..

It's definitely been a busy week. I'm definitely feeling better (mentally at least) from my last post, which now seems to be a very long time ago.

First update, I passed my neuro unit! I only found out today, which I was stressing about for the last 2 weeks but that's another story. It is definitely a huge weight off my shoulders as I was seriously scared that I didn't do well, since the last test involved a lot of short answers (which I despise). I was basically writing the first thing that came to my brain, and after discussing the answers (bad idea) with some classmates realized that my answers were seriously lacking content. Should learn by now not to discuss answers...since it just leads to more anxiety.

Moving on...the next big thing that happened was I started going to a new Jewish philosophical type course with people my own age, and it turned out I really liked it, and actually learned quite a bit. The course solidified my fears that indeed I don't know what I want out of life...sort of scary, but at the same time at least now that I know the problem I can work on trying to solve it. I've realized that a lot of people share the same issues that I've been rambling and complaining about and there are no simple or concrete answers. I've been trying to find simple solutions and in fact there aren't any...so simple eh? I'll try to make a separate post about some of these interesting philosophies a little later.

The good news continued as I found out that I got a rehab placement for my neuro internship. You would think that as PT's in a big city with lots of rehab centres we would get rehab placements but that is apparently not true. In fact some people might not even get one 'true' rehab placement within their education, which is not really fair as others might get more than 2. What many people do not realize is that you have to know what you want and need, and be willing to try, and most people aren't willing to do that and end up choosing the same 5 places that everyone else does or not getting placed. Anyway, my new strategy is to try to pick good spots but ones that others aren't picking as the top choices since they are too 'far' for them. Now since I live far from the centre anyway, my advantage is everything is far from me, so I can pick things that are 1.5 hours for some people, whereas for me its only 1 hour.

The other big news is that I bought, then changed my mind and cancelled a condo purchase. Yes you read that right, me a student, not knowing where I'll work, live, and whether I'll even find a job, decided that hey, let me try flipping/renting a condo....in a sort of iffy area......not even in downtown.....yeah probably not smartest idea. Now to my and my parents defense it could have worked, and we could have gained 20K in 3 years...but the amount of headache that it could have caused, plus the fact that the 200K mortgage would be in my name...not the best thing that I could think of... I'm still not sure it was the right decision, but the truth is that I never really wanted to live there, and gambling on flipping is not smart especially in a 'developing' area, and renting is too much of a headache. In the end, I decided I don't like gambling especially with large debt loads, and would prefer to buy something when I have more security in my employment and actually buy where I could see myself living...I know a radical concept..

Now the bad news..I have gotten sick...yes the horror of having a cold. I know I know, I'm a baby, but hey to my defense, due to my crazy hygiene (read washing hands 20 times/day + not touching anything anywhere) I haven't been sick in over 2 years, which is actually a record for me! Now of course the record was meant to be broken and this is as good a time as any since I actually don't have classes and have time to recuperate. My hope is that if I give my body enough time to rest hopefully it will actually recover in a week without me having to start antibiotics...I can hope right? The interesting thing is my lungs have actually been cooperating and not acting up and hopefully continue to behave.

So that has been my week in a short post, I'm of course doing research (ie writing stuff) which is too boring and deserves a longer explanation. So now to go back and continue resting. Wishing next week is a little less exciting.

drowning under responsibilities and expectations

I seem to go from one extreme to the next with nothing in between. Most days it almost feels like there is no real purpose to life just routines, no enjoyment, just responsibilities. I always keep thinking that if I just finish this one test, this one semester, then I'll truly be free, truly be happy, not really knowing what happiness is. The interesting thing is I don't know what makes me happy or satisfied anymore, so how the question is how can I possible be fulfilled if I don't even know what that will take?

The question I keep asking myself is this why I've studied so much for the past 5 years in uni for, to be miserable? It's funny since today while visiting a condo development presentation, I seemed to have recognized a familiar face from the area back when I lived there who is my own age (24ish), what surprised is that she has a kid a husband....I couldn't stop thinking how young she was and how could she have a baby already? Now of course me being me, I couldn't get the nerve to talk to her because I couldn't even remember her name....but I really wish I could have.

I almost felt as if I hit an invisible wall that I couldn't penetrate and felt stuck from moving forward. In a way it reminded me of my failures in my social life. For all the success I have in school (which I still don't think is adequate), I don't feel like I am accomplishing or growing in my social life. I have no boyfriend, no prospect of a boyfriend, and no place to actually meet anyone. I am very picky and am not willing to accept anyone that does not satisfy my many criteria. If that wasn't enough I have a very moody personality, cannot flirt, and am afraid of going out...so how can I even meet anyone? How can I get married and have kids, if I haven't been in a relationship for longer than 1 month?

Now that I'm done my last unit, am I doing anything fun? no, of course not. My typical day includes acting as a nurse for my grandfather and putting drops in his eyes, as a physio to my dad and attempting to get him to seek professional help, as a diagnostician to my mom and attempt to research the cause of her vision loss and get her to see a specialist. Now I've also added 1 hour of exercising on the weekends at home with a make-shift gym, and of course the now never ending emails and texts regarding the research project....did I mention dealing with my cat's tooth infection?

I still do not have any appetite to eat, and have to force myself to eat at least 3 small meals/day, have lost the 5 pounds I need to have a constant period and therefore have started skipping periods again. I have also started loosing my hair to add to the other growing issues...

The time that I do have, I try to just shut the door and work on my research project but end up looking at the newspapers and going on fb, and forums and being completely unproductive and end up becoming even more miserable...should I get a new hobby?

The only thing I think about is money, but after today and seeing my friend with a kid, I think what's the point of money if you can't share it with someone, or be unable to go out once in awhile and enjoy life?

I'm just tired of the constant uncertainty of the future, the constant pressure to do well and succeed and be able to do it all. There is only so much pressure a person can take before losing it and a lot of people cannot seem to understand this....I feel responsible for the health and welfare of all 4 members of my family and yet cannot keep up with all the medical issues that keep surfacing daily all the while completely ignoring my own issues. Everytime I go out I feel guilty because I know that my mom has more work to do keeping the household running, and it seems everytime I go out there is a new emergency that occurs. Everytime I also have to think carefully will I get sick, will I infect all of my family? Will it take months and many meds for them to recover from a simple cold?

I also feel a pressure from my parents to finish and start supporting myself and helping them.....my dad is approaching his 60's and wants to retire in 5 years, but for him to do that comfortably he has to know that I can support myself, which isn't unreasonably but it's more pressure on me to finish well...get a good full-time job preferably close by....and of course they want me to get married and have kids...preferably soon.....Can I actually live up to all those expectations?

I don't know what the solution is to my never-ending stress, constant emergencies, and high expectations...maybe the solution is to unplug my life at least a little and try making goals for the future...and I probably do need something to help me destress a little and I will probably try reading at least a little each day to distract me from my own life...and maybe I have to try to set up some schedule to try to accomplish the things I need to accomplish. I will also try to set up some boundaries and try to reduce the expectations I keep feeling since it is not helping me and is making me more stressed.

I have to accept the fact that I can't do everything, I can't study in school full-time and then try to also find a boyfriend...given my family responsibilities it is just too much....that also means letting go of the guilt I feel daily and trying at least to do the best I can but knowing that it is impossible and all I can do is try my best to stay on top of everything.

Accepting a bad hand in PT school

It is tough to swallow a bitter pill, especially in life. I came into this program optimistically thinking that everyone tries to keep your interests at heart, but I quickly learned its not the case. Being in a class of 80 people in a way it is understandable that not everyone will get what they want in terms of placements or research choices but it is still hard to accept. I feel that the faculty really don't care what experiences we have as long as we get through the components of the program and I feel this is a very unfair way of doing things. We're also not given full information about placements and are just asked to pick blindly not knowing the exact unit, what it entails and what clinician will be there.

Based on our picking our research project, we were basically asked to rank 10/18, and were told that we would get top 5 when of course a lot of us didn't, and got stuck with projects we didn't really want but were forced to rank. The hardest thing to accept is that I know now that some people will get more opportunities later on when they graduate because of the research that they did and the connections that they made, and that is what annoys me most.

I quess I'm just tired of the unequal opportunities we get that are based on nothing but luck. Now I can't say I would do a lot better if things were based on marks since I'm definitely not top of the class. To me I quess it's just another thing to add of things that I can't control and is unfair.

The placements is a whole other story since there is sometimes no logic on who get's what and it really is based on luck. I have had to employ some really interesting strategies to at least try to get what I wanted, and it usually means accepting something that I don't necessarily want but willing to accept so as not to get sent 2 hours of travelling in the opposite direction. I've felt guilty because some of my friends aren't so lucky and I don't always give the best advice on what they should choose.

Compounding all the other issues is of course that my grandfather has had to move in with us temporarily due to a bad eye infection where we have had to give him 4 diff types of drops 4 times/day, and its complicating matters in our family and making all of us more stressed and he's becoming more depressed.

I quess I have to accept that I don't always get what I want, and I just have to make the best of it because in life you rarely get what you want, at least that's what I learned from my life so far.

Invisible Illness

Last week was Invisible Illness week and Kerri has inspired me to write a bit about it. http://kerriontheprairies.com

My own life is probably not the best example since I don't feel that I'm that different and have to adapt my life that much to cope, and I'm lucky that way. I look normal and healthy and most of the time I am. My asthma is very mild, and if I avoid my triggers I don't have an issue. The problems arise when I try to do something out of the ordinary...this past week, I decided to go to a restaurant with my friends downtown and there was a lot of construction and dust, and that set of an asthma attack which I haven't had in a while and was sort of unprepared for. I started wheezing, hyperventilating, coughing and feeling lightheaded. I of course, tried to hide it for a while and didn't want to make them alarmed but in the end I told them I couldn't go through another construction zone because I couldn't breathe. At the restaurant my breathing thankfully normalized and I forgot all about it.

The incident though got me thinking about the small things I do to try to avoid triggers and how it can inconvenience some people. I generally try to avoid walking downtown because of the dust, cars, pollution and smoke. I try to avoid touching common surfaces (busses), and avoid sitting next to people that cough to not get their cold since its a major trigger. I no longer eat any food outside of my home with my hands for the above reasons, and I almost never accept food from other people also due to the fear of getting sick. Most of these things are really minor to me but for some reason other people find it a bit crazy (just a bit) and even when I explain my logic they still don't truly get it. For them, if they get sick, its just 3 days of a cold, and most can go to school and function normally. For me though, its usually a week of staying home, in bed, with a severe cough and sometimes fever, chest-tightness and wheezing, and them possible another week of antibiotics because the bacteria multiplies more readily. It's ironic that with my phobia of getting sick, I decided to go into the health care field.

Of course this got me thinking about who else I know that also has an invisible illness. My circle of friends and family include people with hyperthyroidism/hypothyroidism, autism, bipolar, 1 eye blindness, Rheumatoid arthritis, PCOS, insomnia, food allergies, liver issues, depression, and leukemia(treatable).

In my own clinical experiences, I've interacted with people with parkinson's, MS, CP, stroke, ABI, cancer, alzeimer's, where depending on their stage/progression, might appear perfectly normal, but are using all the energy they have to make that type of appearance. Is it worth it though?

In the end the biggest difference we can make is advocacy and education. If more people understood the difficulties people with invisible and visible illnesses face, more would be willing to make adaptations to help make everyone's life a little easier. So next time you see someone coughing while you're smoking, consider putting out that cigarette; next time you frown when someone asks you to not being a peanut to school realize that you could save their life and next time you're frustrated that you can't understand someone's speech, realize that they could have had a stroke and are trying their hardest to talk.

Dreading studying and accepting limitations

It's been a difficult couple of days and I'm officially sensory overloaded so have no motivation to study, and just get really distracted thinking about the last couple of days....it doesn't help that there are just too many distractions suck as family members coming into my room constantly and me not having the energy to tell them to leave...It also doesn't help that today's 9/11.

This test is hard for me to study since it is on emotionally difficult topics. Learning everyone about SCI, MS, Parkinson's, CP, Muscular Dystrophy, Polio, is hard because a lot of the time there is no cure and not a lot that can be done to improve people's life and functioning.

In a way I have lost all enthusiasm and motivation for studying the topics since they are so depressing. It's difficult because there is no one I can really talk since my family have their hands full with medical emergencies which are partly my fault, most of my classmates don't take things so personally as I do, but some things just trigger my emotions to bubble up to the surface and I have to constantly surpress them so that my family doesn't get worried. There is some help through the school but I'm too scared to access it since its not always as anonymous as we like to believe. So I end up supressing my feelings, studying from 8pm-3am since that is the time when I have some quiet, and forcing my brain shut itself off.

The worse is the constant pretending that I have to do. You would think that after so many years I would learn how to process all the emotions and thoughts I have but I feel it just get's worse since the doubts, fear, failures and regrets just keep building. The only thing I have learned to suppress everything I feel from everyone around me, so that they keep thinking I'm fine when in fact I'm not, and feel like my head is going to explode.

I realized that being in the hospital, triggered all the negative memories and that is what probably in a way triggered the fainting episode. I was used to being the professional, and coming back as a relative of a patient just caused my brain to shut off since I had no control anymore over anything.

So now, going to try to force my brain to stop spinning, for 4 more days so that I could pass the next test, and then attempt to deal with my issues, although I realized that there is no quick fix and I will probably have to keep dealing with them my whole life. I can't stop my parents and grandparents from aging, I can't control where I will work, I also can't change my personality and be more outgoing, and I can't stop myself from being sensory overloaded from most people take for granted. I also can't stop myself regretting decisions in my life. I have to try to live with all of my issues and either learn to suppress my feelings from others or develop a way to de-stress. I have to accept that my life has not the easiest (although it's tougher for a lot of people) and with the constant moving/immigrating, I missed opportunities to experience what a lot of people take for granted, such as stability, security (although in today's economy that's debatable), and learning normal ways to interact with others (although this could be because of my personality). I will probably struggle interacting with others in English for my whole life since due to my shy personality I was never forced to actually talk to others.

We learn that kids are resilient and even if they don't have the perfect environment they still develop relatively normal, but what we don't learn is that deficits still exist and what one person perceives as completely normal, with more analysis learns that there is a lot of effort and compensation required to appear normal.

I feel like a fraud most days, trying to pretend that I'm someone I'm not. I look with envy at people that don't have to pretend, where they don't care what people think and are themselves. The biggest problem I have is that I don't know who I actually am, since I feel like all I've ever tried to do is study and stay healthy. I am that boring person who doesn't have a life, and all I do is go to school and study, who doesn't go out, doesn't have hobbies or a bf. What most people don't get is how much energy that alone takes, that I have a lot of responsibilities at home, and that my brain does not enjoy going out to crowded places.

How do I develop my identity, if I go from one emergency to another? How can learn to deal with things when I have very few people that I can actually talk openly to and not feel judged? How do I stop the what if's?

In a way I have to come to terms with my limitations and responsibilities since that is what a mature person actually does. Will I ever be outgoing? no. Will I ever like bars/clubs? no. Will I ever stop regretting things? no. Will I ever stop being emotionally moved by events? probably not. Will I ever be truly happy go lucky? most likely not. The sooner I accept these things about myself and stop trying to change the better my coping skills will become. Some things are just impossible to change and one has to learn to live with them.

Ignoring a problem will not make it go away

I've often found myself ignoring minor medical issues and thinking that eventually they will somehow resolve on their own and today I've learned the hard way that ignoring issues only makes things worse in the long-term.

My close relative has always had issues with his vision and we tried to get it checked out but unfortunately didn't get a very good optho and the issue was missed and subsequently we continued to ignore it. This past week the issue became serious fairly quickly with a bad eye infection, scratched cornea, and very high IOP. I felt very responsible since ultimately we should have pushed for more investigations with a different doctor and these issues could have been at least partially prevented. The consequence is that he could now have permanent vision loss in his eye whereas before it could have been temporary.

Some people would think that having some medical knowledge I would at least attempt to be healthier myself and keep my own problems under control yet it is often the opposite. A month ago, I specifically went to do a general annual blood test to see if there are any issues that I need to manage. Well....I learned that I have low iron and B12 levels....now to my defense they were low and not critically low and so I decided to put them at the back of my mind and forget about it, I mean I'm not symptomatic right? Well...if I wasn't then...I am now.

Today during my relative's eye appointment I fainted and apparently turned green and started having muscle twitches....now for some it is not a big deal but this has never happened to me even when I was watching a fairly bloody surgery during my placement so it wasn't the procedure that bothered me. Now I could attribute it to many factors: not enough sleep, not enough fluids, standing for a long time, being in a small non-ventilated office... but most likely the main thing that contributed to it was my anemia which I continually ignore.

This will probably sound very illogical, but my attempt to 'treat' this anemia before, was by dieting to lose weight so that I would go back to having irregular cycles and thereby reduce blood loss and therefore improve the anemia...ridiculous right? The plan of course failed, I was not losing weight since I am already underweight anyway, and my cycles stayed regular, the only result was that my iron levels got so low that I ended up fainting...

I have learned my lesson about letting things go too far, I have realized that since I am a female, I should have regular cycles, and trying to make them irregular doesn't make sense. I have started taking vitamin B12 to improve the absorption of iron from my diet, and have increased the amount I eat. I am going to try to get more sleep although am not sure how successful that will be, but I should try, and I am trying to drink more fluids. I will then force myself to go back to the doc to recheck my levels to see if there is any improvement in a few months. We are controlling my relative's eye pressure with meds and are going back to the optho regularly to make sure it comes down and doesn't start affecting the other eye and cause permanent blindness.

I guess the lesson is don't let medical issues deteriorate to the point where it becomes too late to manage it, everyone needs to take advocate for themselves, and if they think they're not being treated appropriately get another doc or seek a second opinion, and if you're going to treat the problem yourself at least bounce the idea off an actual professional.

Getting out and Seeing things from another perspective

I don't usually go out to restaurants or anywhere because of time pressures and of course because I'm paranoid of germs, but sometimes it does help to get out and get out of the rut.

Today, I got the chance to unwind a bit, eat, and even dance a bit. I got a chance to talk to some friends who I haven't seen in a while, and I realized they're all struggling, struggling with what career path to take, regretting their past choices in their previous university degree, and also struggling to find some sort of trail that will carve out their future.

None of them have the answers and often think about the same things I do. Will I find the right partner to spend my life with? Did I choose the right program to continue my studies? Will I ever be able to move out and start my own life? Where will that new life be?

In a lot of ways, it is harder for our generation, there is no real light shining in front of us, there is a lot of fog, and its up to us to compete in this fog with many others to hopefully gain a path to the future...but in a way it is somewhat comforting that we are all in the same boat, and we all have regrets, and hope and wishes, and not all these wishes come true and sometimes if they do, it is not what we originally envisioned it would look like.

What's interesting, is they look at me with envy, thinking that I have it all figured out, and will finish in a year, and will have a great career supposedly, while they're still struggling getting into a post-grad program, but to me it's funny, since I'm the last person that has anything figured out. I continue to daily question my decisions, and continue to wonder if I will even get a job once I graduate anywhere close or will I have to choose to move far away to find some type of work or bite the bullet and stay here and attempt to start my own practice which is definitely not ideal, since I feel I am not prepared at all and do not have neither the skills, confidence or business knowledge to even attempt it, yet it is possible I might not have a choice.

Today though did mark an achievement for me, I was finally able to let go of my anger and bitterness and become friends with a guy that I went on a few dates with. I was finally able to see why it didn't work, what went wrong, and that ultimately we aren't really a match....now I can't say the attraction is completely gone, but at this new level of understanding I am able to not let the attraction and bitterness take over, and think more rationally about the whole situation and realize that there needs to be a lot more than attraction for a relationship to work and if there isn't than there is no point in forcing it, since it won't work.

My fears, doubts and regrets are not unique, and everybody struggles with a lot of these things in their life. Making my issues to be a big deal is not helping me solve anything, it just makes me more anxious and down. So...I am going to try to keep this in mind, and try to not make every small issue into a big catastrophe since its not. I will definitely try to get out more, since a change in scenery always helps put things into perspective and lets you change up the mundane life we tend to lead.

Placements and feeling stuck

So it is again the time to choose placements, and I'm definitely stressed. Due to my previous negative experiences I see every choice as a bad one. The problem is multiplied since I feel we're not given all the information we need to make informed choices and have to piece things together ourselves. We are given a list of places and a brief description but we're not given the instructor's name or even initials. We also have no way of knowing the different expectations and procedures that each place has and surprisingly the same type of unit in different hospitals can be set up very differently with very different expectations and roles.

It is also very frustrating since I feel we're not given the learning opportunities that we need to have when we graduate since we're at the mercy of what type of institutions are willing to give us a chance. In my current placement, I feel that I am shooting myself in the foot no matter what I choose. I cannot pick any interesting placements like peds ones since I am terrified of not picking things up fast enough and not having a patient instructor. I do not feel ready for any outpatient placements since we did not learn enough in class and would feel overwhelmed...and even if I do pick an outpatient place now it means I wouldn't be able to do it in my last placement and that is a major disadvantage since I hope to work in an outpatient setting.

So the only choices that remain are hospital wards where I end up only ambulating (walking, transferring) patients and doing a lot of paperwork instead of learning something useful for the future. I also end up terrified of picking up MRSA, VRE, or the common cold.

It's tough now, because I feel stuck...I have to keep telling myself that this is temporary, that I will eventually find an environment to work where I will at least not dislike it so strongly, but the regrets never go away. Sometimes I wonder if it ever get's easier or does it just get harder with years when problems just keep building.

I remember a year ago, being so energetic, so awed by the 2nd years who felt so confident, so mature, whereas I felt so green and so lucky to be in the program. A year on, I do feel a lot more mature and more confident but I've lost the energy that I think those 2nd years also lost. I understand the problems of the profession a lot more now and realize that its not all 'helping people get better' and 'watching miracles' its a lot more complicated than that. Its a lot more beurecracy and business. I've also realized that its not accessible to a lot of people and has become a 2-tiered system where the people with insurance can get better but the ones that don't are stuck and are not eligible for rehab (only very basic). The other thing we don't hear about is that not everyone get's better and we can't fix everything, and sometimes watching a person struggle with basic functions in life that we all take for granted or be in pain, and know that we can't help them is the hardest part of the job. No matter how much they teach us that we have to do our best to improve their quality of life, we know that for some people we can't do this and explaining this to a patient or family can break your heart.

We work so closely with patients that sometimes we can't help taking things home with us and their stories never leave us, I wish there was a balance between shutting out all emotion or actually being empathetic, but there isn't. There is either one or the other and unfortunately the ones that are empathetic end up either burning out and leaving the profession or becoming cold and shutting out all feelings since.

I wish had more answers than questions, wish that I could be more optimistic about the future and have the guts to try to fix it instead of watching from afar the mess that everything is creating, wish that life was about more non-profit co-operation and making the world more livable for everyone rather than about profit, greed and fraud. Some days I wonder if I didn't have feelings or a moral compass would life be easier....

On that happy note, I will now force myself to try to forget about everything, shut our my feelings and try to read about 20 lectures. Hope everyone enjoys the weekend, it won't be long until summer is forgotten and the falling leaves remind us of the a new season that we're in.

Old regrets, choices, and a racing mind

I've been struggling in the past few days to get back into my normal studying routine because I've been doing too much and a lot has been on my mind lately.

In the past few days I've managed to decide on a camera as a present for my parent (still debating whether it was the right choice), signed on and closed an online dating account, continued to edit an annoying assignment, dreading upcoming internship choices, and started to doubt my career choice, as well as doubt the future of the city. My mind is now running very fast and I can't slow it down, of course my hormones are making everything worse.

I have always had a problem making decisions. Some people make a decision and stay with it, I can never do that. I will doubt a decision that I make for months, years even and never know whether it was the correct decision and then I start blaming myself that a different decision would have been better. This becomes evident when I go shopping and cannot decide between different items, start trying to make some sort of structure to sort through the different choices and if I decide to buy something, I continue to blame myself that a different choice would have been better.

The same problem with my school, I keep thinking did I make the right choice? Should I have gone to the PA program instead? It sometimes seems I just lose all rational sense. I was reading the forums today and I realized that I do meet the cutoff for one med school and then a light went up and I thought, do I have a chance? Should I go for it? But the question then becomes do I want to go for it? Do I want to be in school for another 3 years + res? Of course all the old wishes came back to haunt me. Thankfully for my brain the decision was made for me and I cannot apply this year even if I wanted to since I'm not finished my grad program. But the nagging feeling remains should I have applied to other programs? Would I be happier in other programs? Will I be satisfied as a PT or always regret my choice?

Next on my many problems is my lack of any kind of dating life. Why? Well the main issue is that there is no real places for me to meet guys, in undergrad, my program was mainly made of girls with an odd guy, and now its the same thing in grad. Since I'm fairly busy, I don't tend to go out at all, hate bars, clubs, concerts and any other crowded spots and so end up at home most time when I'm not in school. So I turn to online dating since I mistakenly think that the more people the more likely to meet someone you like right? wrong. Everyone on it starts looking for a supermodel that doesn't exist. Most guys are not looking for a relationship on it, and end up messaging everyone hoping someone will respond, or don't message anyone because they don't satisfy their requirements. All it took was a few strange conversations on the site to get me to completely lose hope in it and have now closed it. I've realized that it is not the best way to meet guys, and I will just have to wait until I'm done this and when I have less stress to start up my search again and not online.

I just wish that time could slow down and instead of running in a rat cage and trying to complete a 100 things/day I could actually enjoy something small like going outside with my cat, or watching a movie, while instead I end up answering many phone calls, trying to keep medical issues under control, being the family physio that attempts to fix family related injuries since we have no insurance, and try to keep up with schoolwork for which I have no motivation.

Sometimes I wonder how long I can keep going without burning out. Or if I've already reached the burn-out stage. The main problem is that I don't have a lot to look forward to, the future is very cloudy, instead of being clear. Will I get a job when I finish? Will I hate it? Will I ever find a partner? Will I ever be happy?

I try to shut out my true feelings and fears, to not feel anything, and even though I am getting better at hiding them from others, they never really go away. The more I try to deny them the harder they come back.

So tomorrow, I am going to try to put my guard up again and go back to not feeling anything, no more forums, tv shows, reduce news, no dating websites or guys. Just school, since that is what I have to focus on at the moment, and everything else will come later.

Terror attacks

I try to usually suppress my feelings but it becomes difficult to do sometimes. There have been 2 terror attacks in Israel in the past 2 weeks in addition to constant rocket fire in the south, and even though I don't live there anymore, I feel emotionally attached. Most people in North America have no idea what it's like to constantly live in that kind of environment where an attack can occur at any moment, where no place is safe, every bag is suspicious, where going on a bus is every day takes a lot of courage. What do when you don't know if your son/daughter will come back from the army? (which is mandatory for all men and women over 18). What do you do when there is a siren wailing every time a rocket approaches and you think is it in my area? Do I have time to run to a bomb shelter? Should I stay and take the risk?

Most of us can't imagine living in these conditions and often think about England WWII. Yet there are 5 million people that live with these conditions every day and most of the world either ignores them or starts blaming them if they decide to take any action to defend themselves. The question becomes would any western country tolerate this type of environment?

Here I am worrying about my clinical choices and my assignments, and when I have to wake up tomorrow, and yet if we all think about it all those things are incredibly insignificant. My parents chose to leave for the reasons above and were lucky to be able to, but we still have relatives there and most people there do not want to leave or do not have the choice to and this is their daily life and they learn to adapt to ever changing circumstances and fight for their right to live there. I really respect them because it is not easy to continue in these type of conditions, and I hope someday it is possible for everyone in the region to learn to live peacefully like we somehow manage to here in Canada.

My thoughts are with the injured in Israel, as well as the people impacted in US by hurricane Irene, I hope the recovery is fast and everybody is able to return to some kind of normal again, even though the normal keeps changing daily.

'Hope is better than fear'

So most Canadians are probably aware that Jack Layton has died a few days ago and today was his funeral. For those that don't know, he was the leader of the NDP party which became the opposition party of canada. The sad part was that he was only 61 and died of cancer.

I never knew him personally, and I didn't always agree with his political ideas, but it has affected me a lot more than I thought it would. It has ignited something in me that I thought was lost. Through the stories that have been printed and the coverage on tv I realized that he never went into politics for personal gain, it was always to make it better for others. He believed in the basics of life improving health care, education, jobs, and living conditions for all Canadians of all ethnicities. He believed in hope and that's rare for a politician. He also believed that he could produce change and didn't believe people that said it was impossible.

It has been a long time where I've allowed myself to feel anything, and most often am happy to exist with very few emotions. Due to my perceived failures and regrets I had in a way lost hope in life. Co-existing in life is one thing but it doesn't bring happiness. We hear problems on problems daily in our lives, in the news and in a way we lose hope for things to improve. Jack never lost hope.

"My friends, love is better than anger. Hope is better than fear. Optimism is better than despair. So let us be loving, hopeful and optimistic. And we’ll change the world."

Nostalgia during a road trip

Just came back from an 'active' vacation and am totally exhausted and drained. Went to a city that I used to live in and its true what they say when they say you can't go back to the past. I had an okay time, went to some museums, the parliment buildings, went biking around the city on another day and saw some friends we had when we lived there. Of course got overheated on one day and the biking involved a bike with bad brakes which was an adventure in itself but what's a vacation without some adventure. Of course the hotel is another matter which let's just say its not the best idea to stay in the cheapest available option and sometimes makes more sense to pay for something to have a more enjoyable experience, definitely learned that the hard way (bad creaking mattress, smoke filled bathroom, bad air quality).

I didn't go alone (with siblings) and that was frustrating since I quickly learned we don't share the same ideas and trying to compromise was very frustrating. I tended to give in quite a bit since they are guests and in the end gave up trying to voice my own ideas and that caused me to be quite miserable since I didn't really get to do what I wanted to do and just went along with what they wanted. I've realized that compromise should go both ways and if it doesn't resentment builds up. I felt I couldn't really be truthful since they would get insulted and I didn't want to be difficult but I definitely didn't feel as much a part of it and didn't really enjoy the trip since I didn't really have control of anything. I felt the difference as soon as I got home and finally felt in control of my own life again and didn't have to depend on them for making the decisions. Having control definitely makes a difference in your own self-esteem and happiness.

This trip made me realize that a lot of our memories are very selective and we often choose to remember only the positive and ignore the negative. I had always painted the city in a positive light since it was the first place where I had some real friends and I felt a semi-normal teenage years (if there is such a thing). The problem is I forget about all the negative events and when those came flooding back they overwhelmed me (job loss, guilt about my dad living in a different city, friend drama). The city also changed quite a bit and that surprised me since for some reason I keep thinking that everything stayed the way it was and of course things keep changing and not always for the better.

Also for the first time in a long time I felt like an outsider. In the capital I felt like I didn't belong since my native language isn't english or french and I felt like people were judging us, and it wasn't a comfortable feeling, since I didn't really feel canadian anymore. I guess the reason why immigrants move to big cities to be surrounded by their own community is so that they feel accepted, since even though they learn the language, they are never as fluent as the native population and therefore don't feel like they belong. I often take it for granted that I live in such a such a multicultural city and this trip made me appreciate it.

What the trip also made me realize is it takes a family to make a house a home. The house itself doesn't do it. My problem was I felt I could never identify a permanent home since we moved so much but the truth is my identity is not tied to a specific city or house but its tied to our family and wherever we went we made the place a home.

Officially Done 1st year Physio

So today was the last day as a PT1 and in september will be officially be a PT2. Reflecting back, I can't believe a year has gone by, time has just flown by. Granted it was not an easy year, in fact, it has probably been one of my most challenging years. This year has challenged me to go way beyond my limits, and to finally attempt to learn to interact more with others. It has also taught me to try to not sweat the small stuff and attempt to try to enjoy and explore life since it is relatively short and can change at anytime.

The highlights? Being so stressed with school that I started being so sensitive to planes that fly above that I started studying in the bathroom at home. Being so sleep-deprived that I started falling asleep on random people in the transit system. Staying for hours in the anatomy lab trying to memorize muscles and brain structures. Having a very negative clinical experience and having to using some interesting coping mechanism that are not always very healthy, definitely not my best month. Sleeping for 5 hours a day for a whole month while studying. Eating 9 oranges/day + drinking 3 glasses of orange juice to attempt to improve my immunity and counteract the stress. Everyone identifying me as the person that falls asleep in class and entertains all others with my interesting sleep patterns.

Was it all bad? No, I met some incredible people, and become good friends with a few and we had a lot of laughs on those long days and nights in either anat lab or practical lab. Without good friends I've learned its impossible to survive the program. You always need someone to talk to on those cramming days when you don't know if you can learn all of neuroanatomy in the span of 3 days. Or when you're freaking out if you passed another test.

I have definitely grown up quite a bit in the past year, throw a lot less tantrums at home and have a different perspective on life now then I did a year ago. I have started to learn to accept things that I cannot change, to try to stop regretting every decision I ever made, and to at least try to go out sometimes and have fun since there is only so much time that any one person has. I have also learned how to try to relate to patients without becoming emotionally involved and have also learned how to conduct a decent patient interview.

I definitely don't feel ready to be a PT2 and don't feel like I actually know anything except cranial nuclei and how to do a sit to stand, and how to titrate oxygen. I can usually attempt to diagnose a condition but have no idea how to treat it. I'm also terrified about my future clinical placements due to the bad experiences I've had.

To sum up this year: crazy, difficult, tiring, sleep-depriving, stressful, life-changing.

Hope next year, I learn enough skills to actually be more confident with being a PT instead of having to pretend I know what I'm doing. Can I ask for a little less stress perhaps? Probably asking for too much.

Hope everyone has a great weekend.

Bittersweet

So I'm officially done anatomy and managed to pass another test, only one left until the short summer break! It is bittersweet since it continues to confirm that I'm getting older and everything is changing quite quickly and its hard for me to adapt to the constant changes. I just get so overwhelmed that I have no energy at the end of the day, I quess I never knew how exhausting it is to constantly be worrying about marks and the constant social interaction is also very exhausting.

Everything goes by so fast that I have no time to process anything, sometimes I wish we could just stop time or rewind it to a time when it was easier and life was not so complicated. Now each decision I make has consequences and that is hard to deal with. I am constantly overloaded and overwhelmed with daily life and with the pace of change that is occuring. I keep thinking that things will get easier and better but I keep realizing that life get's more complicated and harder as you age. Where will I live in year? Will I be able to find a job in the city or have to move 400km or more for work? Should I try to continue developing a relationship knowing that my family will be dissapointed and that it goes against my culture and not knowing where it will lead? How can I make sure that everyone in my family stays as healthy possible? How can I help my friend who finished her bachelor's, yet doesn't know if she will be able to get into a graduate program? What can I do if I think the country is moving in a wrong direction? Is it just a heat anomaly (it is now 38C with a humidex of 49, above 30 for the past 2 weeks, and no rain) or is it the start of climate change that we can't reverse and are we all doomed?

These are my daily thoughts and I have no idea how to deal with them and get very overloaded by the end of the day that I end up passing out, today I fell asleep on an unsuspecting transit rider because of pure exhaustion and heat. Of course functioning on 6 hours of sleep and very little food, and no rest doesn't really help my brain cope with all the constant change. I know that there are no easy answers and that the end conclusion is that life is hard and doesn't get easier, but the transition is extremely hard because whatever decisions I make are mine and I can't blame others for them as I used to do.

Most days I think back to high school and summer vacation and the days when I was actually happy and really long for those lazy days where I would ride my bike with my friends and play on the swings and play in the woods....I just feel that I have no memory of the last 5 years where I was either studying, working or dealing with emergencies at home. I quess what I want to go back to being a kid and stop maturing and becoming a adult (yes at 23 I don't consider myself an adult) because it is an escape from my current problems which seem never-ending and have no easy solutions.

Well rant officially over, time to go to surviving another test.

Taking on the world's problems

My biggest problem is I tend to take on other people's problems and emotions and that just depletes my mood and energy and I still don't know how to deal with these things. The problem is that there are too many problems, the US and Europe debt crisis, high unemployment, high youth unemployment, immigration issues with my neighbours, my friends problems, Afghan war, family issues, reductions in health care, oil crisis.....therefore my negative thinking continues and all I do is read more and worry more and the cycle continues. I know that most of these problems are not my problems but I somehow feel responsible for fixing them, when in reality I know that I can't and ultimately it's up to the people with the problems to try to fix it and unfortunately sometimes you have no control over life's circumstances no matter how much you try to control everything since I am one person and life depends on the interaction with many others.

This has gotten me in trouble before and whenever I try to suggest to 'fix' something, the end result is usually not the one I envisioned, or it becomes the opposite to what I wanted anyway.....but how can I be happy when so many others are miserable? but how can I help their misery when I'm miserable myself....

I've learned that I do feel other people's pain more than other people and that is just my personality which some people will say is a good thing since it makes me more compassionate but my job requires me to deal with people with pain all day and to do that I have to be objective and less emotional since being emotional does not solve their pain problem....of course hormone issues don't help, sometimes I envy guys that have a lot less emotions and look at everything much more as cut and dry which I could try to follow....

So, now I'm going to take a deep breath, and focus on my own problems which is a looming test tomorrow, and forget about the world's problems for a day, and then maybe if I want to change something, actually proactively do something instead of worrying about it. The reality is the world is changing and I am one person out of
7 000 000 000, and no matter how much I want to, I cannot change it for the better or fix its problems. Change is the only constant in the world and we don't know what the next 10 years will bring, we don't even know what the next year will bring, will oil run out? Will global warming cause increasing drought? Will there be a major infectious disease that will affect the world? Will China become the new superpower or will we go back to living in caves? The possibilities are endless and I have to stop thinking this way since all it does is make me miserable since all the outcomes are negative, but all this thinking will not stop the time and will not stop change and the best thing one can do is adapt to the changes that are occuring.

My life even 10 years ago was very different than my current life, and my parent's life 30 years ago was also vastly different and yet even through all the changes they managed to adapt and survive and even thrive and they unlike me do not keep regretting the choices that they make. Maybe that's the solution, to learn to live with the choices you make and with the consequences those choices will have since all choices in life have consequences.

Overwhelmed and frustrated

It is the last 2 weeks before a month long break and I feel like my mind is about to explode. In the last week we had an annoying assignment due, 3 overwhelming and intense clinical sessions that I've still not processed, a practice clinical test, and case study, and next week we have an anatomy test which I feel completely unprepared for. Why am spending so much time memorizing what happens when you lesion cranial nuclei, instead of actually learning about neurological diseases? Very, Very frustrating, I feel like its back to the undergrad education where you try to cram as much info as possible and forget about understanding anything...except the pro

The summer and constant nice weather doesn't help, nor do the constant thought about what I will do in the month off. My dating experiment is also not helping....I feel like it is just too much, I sometimes wish I could just shut off my feelings and though process and become a robot, that would make studying more productive. Seeing the brain injuries people get, now make me incredibly paranoid of driving, biking and even walking lest someone runs me over, sometimes I question whether I made the right career choice, the thing that keeps me going is that there is no other option for me, well except working in retail for min wage.

Now officially back to studying all 12 cranial nerves and nuclei...

Little Control of the Future or the job market

I love to plan and really dislike uncertainty and change. It sort of goes with my personality but that's for another post. As before unknowingly I tried to plan the next 5 years until I've realized that it most likely will not work out that way. My plan? Let's see finish PT school, find a outpatient orthopedic practice willing to take me a new grad full time that is preferably within 30min drive from my parents house and physiotherapy owned with lot of support for new grads, let's see then save enough money, find a jewish boyfriend, buy a house and have 2 kids, then open my own practice.....

Even to me it starts to sounds a bit ridiculous...there are a few detours that are already occuring....first off the job market is bad for all new grads and physios are not excluded, everyone wants people with experience and are not willing to invest in training so unless I get really really lucky I will either end up with part time outpatient ortho clinic that is 2hours away. Which means I will have to move away from home....or if unlucky I might have to go work up north which is 4 hours north and work in a small town and do everything including acute, rehab, outpatient and home care which is challenging... and the bf? well so far I don't get along with any jewish guys and now am dating (sort of...) a non-jewish guy, so so much for my great plans. House and kids? Well with my luck the house will be 2 hours away from my work and I'm not even sure I can easily have kids since my periods are irregular and sporadic since my percentage of body is really low (no I'm not anorexic, I just do not feel very hungry and dislike most sources of protein).

It doesn't help that I keep blaming myself for everything and thinking if I could have changed something would my life be better? would I or my family be happier? Or would my life be so different I wouldn't even recognize it?

I keep trying to move forward and forget about the past and everyone else's problems which I can't fix anyway, and yet keep getting sucked back in and keep feeling their pain and frustrations and of course my own issues that I am constantly trying to forget and control.

I look at people in my class and wonder why aren't they as stressed or as miserable as I am? Do they have to work as hard to understand and interpret social cues and what you can and can't say? Do they need alone time to recuperate from social interactions?

I know I shouldn't compare myself to others because everyone is different and has different issues but sometimes I wish I could stop being so sensitive to everything around me and be able to interact more easily with others and not have to try so hard and find that others still find me weird.

Ok rant over. My plan? Accept fate, if I end up in a small town 4 hours north so be it, maybe I'll actually like it there. If I end up marrying a non-jewish person it's not the end of the world, since nothing turns out the way you plan it.

Right now I have to stop procrastinating and continue studying since at least that much I can control. I have to forget about the future, since I have a test in 1 week, and assignment and assignment due in 4 days.

Over and out.

Shades of grey

I realize now that I used to view the world as either black or white. Things were either right or wrong, and good or bad. This program has drilled into me that for a lot of things 'it depends' is often the answer. At the beginning this really frustrated me since I wanted to have a concrete answer but I realized that life is a little more complicated and often there is no real 'right' answer and no 'right/wrong' treatment.

I have also realized that I often judged people before really getting to know them and often labelled them as either good or bad when in reality people are different and are human and everyone has good aspects and bad aspects to their personality that is what makes us human if everyone was perfect we wouldn't be human and would be more like the stepford wives. The thing is in any interaction it takes two to tango and therefore I could be viewed as the 'bad' person by them and in reality personalities clash and sometimes 2 people with different personalities just don't get along and it doesn't mean that one person is 'good' or 'bad'.

Disability can also be subjectively viewed as shades of grey. I used to feel sorry and feel sympathy for being that are 'disabled' but I've realized that a disability can mean many different things and as a future PT I can't really help my clients if I feel sorry for their situation. Everyone has their own issues and we all could in some way be labelled as 'disabled' there is no such thing as a normal person. I myself get very anxious in large crowds, have trouble interacting with others, am sensitive to noise as well as having mild asthma, does that mean I'm disabled? Is the person with the peanut/gluten/milk allergy disabled? Is the person with an knee ACL tear, or torn meniscus that can't ski anymore disabled?

Everyone has their own problems and what distinguishes people is how they deal with those problems. Do they accept them and learn to live with them? Or do they become depressed and wallow in self pity? 2 people with the same can have 2 different ways of leading their life and ultimately how they do it is up to them.

My role is to help them achieve as much independence as they can and then to recommend devices or methods to compensate for things they cannot do. This can mean using a cane, walker, wheelchair for safety/balance/mobility or learning to compensate with a stronger side after a stroke and retraining to their good side to do things they did with both sides before such as eating with one hand or transfering with one hand.

In the end life is full of challenges and it is not the challenges that define who we are but how we deal with those challenges.

Letting fate decide your future career

It has become so competitive to get into any kind of professional program in Canada that a lot of people apply to 10 different professional programs and let fate (or the admission committees) decide what their life-long career will be. I am talking a lot about crazy pre-meds mostly though that end up applying to med, dental, PT, OT, Pharmacy, Optometry and even lab tech, ultrasound, x-ray tech. Yes they apply to ALL these programs in one year!

Now people can argue that a lot of these programs are all medically related and as long as they're satisfied does it really matter what they end up doing? Well that is one argument, the problem is often they are not satisfied and drive up the averages to the point where the people that actually wanted to do that specific specialty can't get into the program and only the people that chose it as a back-up can.

Now I do partially fall into this category but to my credit I did only applied to PT and did not apply to 5 different programs. On the other hand it could be argued they at least these people are sensible and realistic and do not keep trying to get into Med for 10 years and instead choose something different. I think the main problem that has occured in Canada is that it is so hard to get a decent paying job (not min wage) that people agree to do ANY career that pays decently and so most people are now motivated by money and not interests. The reality is that most jobs now require more and more education and having a bachelor's does not guarantee any job. Most people with a bachelor's end up either working min wage in sales, call centers, teaching english overseas, or doing a research master's that unfortunately does not increase employment skills since the projects are very very specific. Some lucky few with high enough marks are willing to settle for any professional programs as long as it has a decent wage. This just illustrates how great the economy is when everyone is forced to apply to multiple programs and don't care about what they end up doing in the end.

Now below I have illustrated the typical hierarchy of careers, and keep in mind all of usually require an A average in University undergrad courses to get into:

Med>dental>PT>OT>Pharmacy/Optometry>Lab tech/ultrasound, x-ray tech>nursing.

Impossible to achieve good school-life balance

There are some people that are in my class that I am just amazed at and have no idea how on earth they can do the number of things that they do. I will probably regret in the future that somehow I could not do more social activities while in school but in reality I really really couldn't.

I'll try to explain my day, wake up at 7am, 8am-9am-transit, 9-4/5pm school, 4/5pm-5/6pm transit, 6-8 eat, organize,talk with friend, 8-12pm study, 12-7-sleep. Yes this is my normal day, and on the weekends I normally study for 8hr/day. Yes this is my life while I'm in class and yes I do study this much.

Why do I study so much? Is it really necessary? Well the problem is I take longer to understand and absorb information than a lot of other people in my class. This is considering that I am actually a lot more efficient at listening in class and no longer need to record and relisten to lectures. Also considering that I barely passed the last unit, I feel I do have to work a lot harder than others to survive.

Because of my intense schedule I have to confess that I have never really dated and have never had a social life that involved going out a lot and meeting with others. In recent days I have had the opportunity to try dating but quickly realized I couldn't handle the extra work involved and yes I did feel it was work! Even though it only involved texting and possibly meeting up once in 2 weeks I felt overwhelmed. I was barely surviving as it was and already sleeping only 6 hours/days so adding to that constantly checking my phone and planning weekend 'dates' was close to driving me over the wall.

Most people in my class are able to go to school, study, go to the gym/play sports, meet up with gf/bf, and go to parties with friends and sleep. I honestly have no idea how they do it. Now it's true that most of them don't commute and don't need to help family but they do have to cook and deal with partying roomates. But my question is where do they get the energy to do all that? I'm exhausted after being in class from 9-4pm every day, I would not have the energy after class to go play soccer for 2 hours then study for another 2 hours, or go to a party after class, I would just fall asleep.

Most people question how I live without going out, or playing sports, or meeting up with friends every week, but the truth is if I did that I would not be able to keep up with studying the insane amount of info they expect us to know and continue staying healthy and sane because for me it is a daily struggle.

I realize that the 20's are supposed to be the best times of my life and yes I have made sacrifices and yes 6 years is a long time not to have a life, but the truth is I have realized my parents sacrificed a lot more for me to have this opportunity and it would be a waste if I didn't try my best to succeed. In the grand scheme of things I only have a year left and after that my life is my own.

I have felt like I'm on an emotional roller coaster ever since starting this program. I have gone from feeling like being a chicken with its head cut off because my brain was in so many places at once, to feeling like a walking zombie due to lack of sleep, and of course going from depression-> anger in the course of a day, and it took me a long time to learn to regulate my emotions and learn to survive because I have realized it is definitely not easy.

I have accepted that I can't do everything especially when in school and I do have to try a lot harder and study a lot more than a lot of people but that's okay since everyone is different and my path into this program has been an unconventional one as it is so I wasn't surprised when I found I had to try harder. Everyone's energy capacity is different, and whereas others can party after school, if I try that I will either have an asthma attack, get food poisoning, or get sick from something else and will greatly inconvenience my parents so in the end its not worth it.

I do realize that I have not achieved a balance and will keep pushing my body and mind further but I do realize there is a limit and have to be careful about reaching that limit. I am satisfied that I have already managed to achieve a lot more in the past year than I have in the past 4 years in undergrad, such as having meaningful relationships with school friends, conquering my speech anxiety and constant stuttering, developing an ability to communicate and treat patients, and waking up from my never ending depression and seeing hope.