MEG2MD

TODAY [x] reconcile YNAB [x] LIFT!!!!! [x] choose recipe for dinners this week [x] instacart dinner, lunch, snacks [/] reset EZ pass for reimbursable tolls [x] buy beer and NA beer [x] halloween party :)

TOMORROW [ ] laundry/dishes/roomba [ ] email answer key and resources to med students [ ] reach out to M4s about surg skills [ ] cook [x] start SGS manuscript [ ] email GF about IRB/DUA [ ] ask JC if JH study going anywhere [ ] cancel Patreon, NYT [ ] pickleball

At some point... [ ] email MIGS contact from jfd [ ] ask JF to text friend in MIGS [ ] ask JZ if onc study updates (maybe when on onc)

It's my last week of nights, but like I said before, even though it's ass and I'm constantly in a state of existential dread, the hours are considerably better than normal day shift hours and I actually have a relative ton of free time as long as the floor isn't on fire and I'm not expecting transports. I read through all 41 volumes of Berserk in the past 3 weeks and have (almost) recovered from the emotional trauma it inflicted on me, and now I have one week left and no hyperfixations that call me too strongly. So I guess I can work on getting my life together lol.

Academic responsibilities:

M&M - draft due Tues, about half done

CREOG - test in January

ACOG - need to make AROM demos and borrow some amnihooks/FSEs, e-mail about borrowing CE demos, end of Oct

M3 surgical skills - submit simulation center form!!!!, next month

Urogyn - prepare for surgical cases next block by reading/watching videos, next week

Conferences: book hotels, flights; schedule reimbursement - this month

Research: meet about SDOH study paper; log into Athena to prep for data collection for Sedation project; touch base with JC about if AI study going anywhere

Fellowship: app in May, the biggest things are figuring out when/how to ask for LOR and drafting a personal statement. And then hoping my extracurriculars and research are enough :( also potentially an away rotation for end of March/early April - need to meet with MIGS ppl next week to discuss next steps

But the most stressful thing that's been weighing on me for MONTHS is my finances and disorganized spending. This week I REALLY REALLY REALLY want to get my budget it order. I can't even imagine how much my stress levels will improve if I don't have this crushing dread about my finances hanging over my head. This includes

Figuring out loans and how/when to pay them back

Budgeting software (I used YNAB previously)

Paying back my friend who lent me money for vet bills

Calling insurance to see why therapy costs so freaking much

My spending has been out of control!!!! It is like, the absolute worst, most damaging symptom of my ADHD that I don't have a good handle on yet, especially when I'm so dysregulated from nights. I thought I could work on it over the weekend but alllllll my limited, limited energy was spent on basic self-care (laundry, dishes, cleaning floor) and I had NOTHING left.

Anyway. Today is for starting on the budget journey and working on M&M. Maybe I'll log into YNAB and reset some things and just start over. ho hum

I'm just..... so beaten down, so tired. I have so much existential angst. Like idk that I'd want to do anything other than medicine in my life, but like..... what's the point of living ? Lol. Is this all there is? I don't have a partner, I don't have many friends near here. I don't want to not be alive but I like, need a reason to live

Finished Volume 41 of Berserk, the last of Miura's work before he died, and I am unwell. I can't believe I didn't know about this series before recently!!!! I'm wrecked. It got me through the first three weeks of this night block, but I'm not sure how I'm supposed to survive the last week when I'll just be perseverating on the unfinished story :(

I still have work I need to do (M&M, AROM/FSE demos, surgical skills session paperwork) but I'm just not motivated.... All I want to do is re-read Berserk, go to the gym, and roleplay Guts and Casca fucking shit up in various video games :') at least I have this weekend off, because I've worked essentially three weeks straight and I'm tired

I got my first pull-up back at the end of August but haven't been able to progress past 1-2 with "ok" form and we're mid-way through October. I pulled the trigger on a pull-up bar and am going to try and focus my gym workouts on training specific muscles used for pull-ups but not unassisted pull-ups themselves, since I think too much of my limited gym time is wasted spinning my wheels with possibly questionable form when I could just do them at home when I have a spare second. I feasibly can only make it to the gym twice per week. There's just isn't enough time in residency to get all my extracurricular work done, clean my apartment, and enjoy life/hobbies/friends if I do any more than that. Which is sad. It's like, what's the point of life? Will I look back in 10, 20 years and actually be happy with everything I've accomplished? I don't think the answer is necessarily "yes" right now because I'm lonely and overworked and not sure what the point of anything is (lol I'm doing gr8) but that's another discussion. The only thing I know is that my physique/fitness/athleticism is one of the only things even remotely in my control, even if it still feels mostly out of my control due to residency constraints (poor eating habits, no time)

And yet we struggle on (gatsu <3)

I lost my 24/7 keycard to my gym so I'm going to hit the nursing school "gym" when I get off in the morning, plan for a "pull-up supplement" routine as follows:

Elliptical warm-up x10 min

Should rolls with bar, straight arm for warm-up

Inverted rows (with rings if able, otherwise barbell)

Bench press

Seated cable row

Superset tricep dips/t-arm raise

Superset dumbbell pull-overs/y-arm raise

Straight-arm Pushdown

Wide-grip scapula pull-ups

Dead hang

Ab exercise/hollow body rocks

General things to focus on for pull-ups:

External arm rotation for scapular activation, chest up;

Generate push-up/pull-up/bench press from muscles between shoulder blades; don't pull from hands - imagine arm is upper jaw, side is lower jaw and "biting down" to close versus "pulling up" (drive from your lats)!;

Body curls - bring legs up to bar

Target wide grip because it's my weakness, can focus on lats and small shoulder blade muscles

Practice hard movements, assisted if needed, to develop neuromuscular patterns - don't break form!! Stay within ROM with good form!! High rep/volume these movements

[/] Work on JFD presentation [/] Finish reading fibroid PB for M&M [ ] Drop rent check off in hospital mailbox [x] E-mail about sedation project - meeting/IRB updates [ ] Fill out sim center paperwork [x] Draft work-out routine that will max pull-up progress when I only go twice weekly :') [x] Buy plane ticket for cabin trip

Tomorrow I will

[ ] Work on M&M [ ] E-mail sim center about CE demos

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Already napped 1.5 h. Will read Berzerk until just before downtime and update all vitals/UOP prior to that, check ED for consults, check bed board for transfers. Then work on extracurriculars until downtime over (2 h).

So sleepy. So tired. Residency is hard.

Dumbbell row, barbell row

Seated cable row

Narrow grip lat pull-down

Straight arm pull-down

Dumbbell pullover

Inverted row

OTHER

Wrist curls

NOTES

Keep chest upright

Shoulders back/externally rotated - do not shrug shoulders!!!

1.5x grip width

But I'm so, so tired, and so, so dysregulated, and I don't know how I'm going to accomplish all these obligations that I have without being too overwhelmed and drowning. I'm trying to chip at them slowly, but even small tasks feel insurmountable.

My life, in two pictures:

Exhibit A, trying to get swole but only succeeding when the lighting is on point, and still failing at pull-ups by trying my damndest

Exhibit B, my re-ignited love of Naruto, as well as a new obsession with non-alcoholic beers

That being said, I did drink... way too much last night. I went to trivia and truly would have been okay with 1-2 beers, but then a friend came late and wanted a drink, and my other friend is going through a rough time and wanted to go back to my place and keep drinking... and truthfully at ANY POINT I would have been okay with an NA beer, and I know for next time that I shouldn't give in to peer pressure and keep drinking. I'm confident I wouldn't have kept drinking on my own (which used to be a problem in college and medical school - binge drinking!!) and that I can do better next time. So even though I was hungover today and felt a little bit ashamed, I was able to be there for my friend when she needed it, I still went to my tennis clinic, and I know next time I'll be able to intersperse more NA beers and overall drink less.

And honestly, overall the past few months I have been drinking DRASTICALLY less and it's been very good for my mental, physical, and emotional health. Go me. I'm very proud.

Despite it all I'm actually somewhat on top of things, even though I spent most of the morning sleeping in bc I stayed up until 2 AM with my friend drunkenly singing MCR and Evanescence, and then it took awhile after tennis for my hangover to go away and for me to feel awake enough after extreme physical exertion while slightly hungover to get anything done. But I mayyyyy have this abstract I've been working on ready to submit for SGS if all goes well, and I'm also hoping on to be a middle author on a project with one of my co-residents which will also get submitted to SGS! And I actually have two ORs I can go to next week to film this video idea I have - submissions for the conference I want are due 8/8 so it's pretty tight and stressful but doable. I'm just gonna be SUPER busy next week with video stuff, in the same way i was SUPER busy this week with the lit review/IRB prep for my other project.

I'm gonna go crash into oblivion. It's already been a week of my research block and me not needing to be at the hospital barely at all but I feel like it's gone by so fast since I've been relatively busy working on all the things above. I'm definitely not efficient - a more competent research-oriented resident could probably have done it in a fraction of the time. But hey, I'm at least being academically productive, AND I played tennis, AND I'm going to two concerts this month, AND I've been allotting video game time to the start of every morning I don't have to be at the hospital.

All in all I think it's actually worked out nicely that I didn't rush to get an away rotation together last minute. I have 3 projects to work on at home AND I get to do things I like around the the neighborhood like watch Naruto, play tennis, read, and go to the gym. And I saw a pic of my ex earlier and while I was a little sad and nostalgic, it didn't rip me up like it used to (yes it's been 1.5-2 years w/e I love swiftly and deeply lol), and it just further motivated me to kick ass and be super swole and hot and buff up my CV >:)

At some point I need to switch gears and work on my other tasks: prepping for PBLI tomorrow, which I 100% forgot about until this morning, and prepping Family Planning and my continuity clinics, + clinic reading. :') And less time-sensitive, but I need to start getting shit together for my MIGS video, actually make med student surgical skills a thing, do some prep for med student workshops at JF Day, and compile my resources for the ResidencyCAS webinar I did a few weeks ago.

I say this all the time but it's honestly stupid how effective the Vyvanse is at home. At work I barely notice it. And to be fair, even at home without it, my baseline drive is enough that I'd probably get SOME things done, but I'd be exhausted and half as productive. Like, I've literally been doing literature review and other miscellaneous academic tasks since 1040 (it's 2 PM) and even cleaned my apt a little bit to prep the Roomba to run. Normally one of three things would happen: 1) that'd be IT, I'd be TAPPED OUT, 2) I'd have done half as much literature review in the same amount of time, or 3) I'd struggle to even start because I'd be addicted to the dopamine rush my video games give me, and I'm on a research block and I can always work on it ~tomorrow~

Today is for dicking around. A real weekend!!! Nothing to prep for on Monday!!!

MONDAY TASKS [x] LITERATURE REVIEW!!!! Meeting is Tues [ ] PBLI [x] 1300 meeting for syphilis algorithm :( [x] E-mail EL/VB about hysterectomy trainer [x] E-mail JS about second-authorship possibility [x] Prep FP clinic *** [ ] Watch TLH video, type out steps - T [ ] E-mail NR, LT, JS, EL, RC (MIGS/Urogyn basically) to meet and review video project - how they dictate manipulation, assistants [ ] Surgical assistant video? [ ] Email NR asking feasibility of filming in next 1-2 weeks - may interfere with gyne people, but may be able to sit in while resident operates to be manipulator; cc EL - W [ ] Assemble surgical skills people in a group text and add to my Google Drive - W [ ] Resources complilation for ResidencyCAS webinar - W [ ] E-mail CH/CG to start JF Day planning - W [ ] continuity clinic prep - R [ ] Clinic reading - R

[ ] Watch TLH video, type out steps [ ] E-mail NR, LT, JS, EL, RC (MIGS/Urogyn basically) to meet and review video project - how they dictate manipulation, assistants [ ] Surgical assistant video? [ ] Email NR asking feasibility of filming in next 1-2 weeks - may interfere with gyne people, but may be able to sit in while resident operates to be manipulator; cc EL

[ ] Text for surgical skills [ ] Text CK for JFD and bar cart [ ] Type paragraph of literature review - send to JS, RC and tell them it's my research month [ ] Gather all submission dates: ABOG, ACOG, AAGL, SFP [ ] Type resources to be sent to CG for app webinar [ ] Figure out where to meet Jackie!!!

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Eclamptic seizure last night iso severe renal dysfunction learning points - 4g MgSO4 bolus, 2 mg Ativan, 1g Keppra loading dose - CMP w/diff, CBC, Mag/Phos, TFTs, PT/INR, aPTT, troponins, POC glucose, EKG, CT head non-con +/- lactate, peripheral smear, ADAMSTS-13, haptoglobin, LDH, blood/urine cx?? - NPO, IVF @ 50-75 ml/h - MRI brain +/- MRA/V - MgSO4 1-2g bolus to goal level 4.8-8.4, check q2 h and if <4.8 administer MgSO4 then recheck 1 h - Treat severe range as normal - Evaluate other causes: abdominal bleed? Infection? Toxic metabolic etiology?

Thank god I had a good team. I'm tired today because I had clinic (which I despiseeeeeeeeeee), helped lead the med student shelf review until close to 7 PM, then JUST finished my continuity clinic notes, rounding assignments, and prepping HROB patient notes for tomorrow. It's 9:20 PM. ;( And the Mondays after a Sat-Sun 24 h shift feel like I got hit by a truck.

Highlights: no one died

I called (kinda, the attending technically did but I was thinking it, so it counts) and did my first stat section and managed the oncology service with no one dying. Although someone DNR/DNI with horrible cancer who was 2 seconds away from CMO anyway developed a fever and I was like ???? do I work this up or not lol. Called my fellow, we did, but then day team made her CMO and stopped it so there ya go.

I had a soft-ball first call cuz I had an all-star attending line-up, the fellow was on for oncology so I didn't have to call any scary attendings, and my two onc transports didn't come. Also I had an R4 shadowing the intern for the first half of the day so I could ask dumb questions.

[ ] ADHD meds in pregnancy [ ] DDAVP/vWD in pregnancy [ ] Multifetal gestation including triplets [ ] cardiomyopathy in pregnancy [ ] type 3 FGR in multifetal gestation [ ] candida glabarata iso pregnancy

Other things based on clinic reading [ ] GnRH agonists vs antagonists indications/uses [x] type up bleeding in adolescent onc pts committee opinion [ ] antifibrinolytics MOA, uses, contraindications [ ] KB, fetal bleed screen

Also my R4 is out tomorrow so I'm chiefin' for a half-day before clinic and then for signout, so uhh, yikes. Good practice before my Saturday 24 h chief call I guess. Gotta take the plunge sometime. R3 is really a growing year, and it's so different that R1/2 growth where you're just learning how to function. Like, obviously I still have a LOT to learn in terms of knowledge, especially regarding general gynecology, gynecologic oncology, and high risk obstetrics, but now I need to figure out the "other" part of residency - learning how to lead a team.

What's my leadership style? How do I delegate and make sure tasks are done without being overbearing? Who gets what procedures, especially when I'm still smarting for three-peats and arrest of descent sections? How do I be "in charge" without letting people walk over me? How do I project confidence without arrogance, or confidence in the setting of knowing I still have a lot to learn? How do I become trustworthy by my R4s to handle my tasks, so that they can give me some leeway and focus on the juniors? How do I teach? How much time do I give before I step in? How much do I let my interns fumble? How much do I correct before I say "it is how it is, they'll figure out how to be better"? How do I have a cohesive signout on the ENTIRE floor when my juniors are the ones (in theory) doing all the active management of labor, antepartum, and triage?

100 push-ups per day, 100 sit-ups per day, 1 plank 60s or more per day, for 30 days. Eventually hold 5-min plank. Does not have to be done all at once, I'm thinking like 10 sets of 10 push-ups per day and maybe 2 sets of 50 sit-ups. And then a plank whenever.

This month will try 25 push-ups and 50 sit-ups every other day, then progress to 50 every other day, then 50 every day, then 100 every other day, then 100 every day

Allowed to skip days I go to the gym for other stuff (2-4 days/wk)

I squat and deadlift enough at the gym already, and I need push exercises to balance out all the pull exercises I do for pull-up prep

Nesta stair challenge goals:

111 steps down and up (pgs 96-97)

1,000 steps down and up (pgs 211-212)

3,000 steps down and up (pg 308)

10,000 steps down only (pg 478)

10,000 steps down and up (pg 630)

I feel like I missed some, like I could have sworn she did 8,000 at one point. Anyway. At some point will also need to work on ~mindfulness~ and ~breathing~ a la "mind-stilling" hahahaha

And then obviously my long-standing goal of being able to do pull-ups by the end of R3. Right now I can do 4 chin-ups and 0 pull-ups, but I've been focusing on exercises to help my engage my lats. All things considered not a bad place to start.

By the time I graduate residency (2 loooong years from now), I want to be a BEAST. I refuse to let my physical fitness slip. The gym is the only place I feel confident, competent, and, well, pretty lol. Residency makes me feel unliked, unlovable, and incapable. And yes, a lot of this comes from my own mental-illness-ridden head, but the feelings persist regardless.

Yeah. Reasons I identify with Nesta so much. My fantasy books and the gym are the only things that keep me grounded, keep me from becoming someone I hate.

EDIT: found this, seems more reasonable than jumping from 3,000 to 10,000. Although tbh part of me wants to go BOTH down and up like Nestie

[x] Grab laundry from dryer, it's been three or four days lol [x] Assign antepartum rounding for Monday [x] E-mail JY [x] Assign HROB clinic prep [x] Do HROB clinic prep :c [x] Prep Monday clinic [ ] Instacart [x] Practice webinar [ ] Update CV [x] Gym: Pull-Ups vs stair challenge [x] Return library books [ ] COI

Also, there's actually a lot of good information in the Green Journal. Gonna write down thoughts as I go thru it to file away for later

Notes from ACOG Green Journal 6 2024 - Early first trimester ultrasound 12.5-13.5 weeks in conjunction with NIPT [ ] Type up CES on inpatient management of HG

I was a fucking mess last week. Depressed. Not good to be around. So bad that people were/are actively worried about me. But like, that's what you freaking get after 5 weeks of nights in the setting of my apartment becoming actually unlivable, AND it's ninety five thousand degrees outside, AND I'm adjusting to being a senior, so new roles/responsibilities/etc

Looking at the interns, I do see how far I've come. I was in their shoes, once: struggling to find a cervix, falling behind with inductions/mag notes/strip notes/postpartum calls, scared of decelerations, unsure how to piece the clinical picture of labor together. I'm efficient with things I know how to do. Keep me to ante/gyne and I'm ON TOP of blood pressures, blood sugars, consults, antepartum calls etc. I feel pretty good about up-titrating blood pressure medications, deducing superimposed preeclampsia from chronic hypertension exacerbations, managing PPROM +/- PTL. I've read a lot. I think my signouts are decent.

But now as a third year, the antepartum "chief", I am really, really struggling. Now I have to delegate. I need to figure out what things I do, what things I have the second year do. When my actual R4 L&D chief is off the floor, I'm then in charge of everything (including training the day 3 intern). What's REALLY hard is the power dynamics. I'm in charge of the antepartum service, but my R4 is still in charge of me. And then on top of that, different R4s have different opinions, and then I get caught in the middle!!! A patient came into triage today, ruptured with twins, concern for preterm labor. I was told to let the R2 see her. I did, then sent the R2 home. Then the night team told me I should have seen her instead. And the R2 should be doing XYZ. And my signout wasn't well-prepared enough about her (even though I thought it was decent). Which to the first point, like, fair. I tried to have my R2 doing the XYZ. But I was also told to have her see the triage patient. So then it's like I'm in charge, but actually I'm in "charge", and the different people who are ACTUALLY in charge have different ideas about how to do things, but then it's either I take the blame or throw someone else under the bus.

And obviously, there are learning points. I can always know more about the patients. I think I did a fine job, especially since I've been on MFM/antepartum for TWO MONTHS STRAIGHT, but I do need to know the patients I don't admit a little better. And when my R4 can't come to signout, I really should know the floor better. These are things that will come with time, I'm sure. I am three days into my first time being a senior. I'm learning not only how to cover an ENTIRE service, but also how to manage an intern who needs to learn, well, literally everything. And can't do anything by herself yet. (Like I said, it's fine, we were all there at some point.)

But it's really, really hard to be told to do your job different ways from different people, and then you have to take responsibility for it anyway, and also you're supposed to be in charge of a service but you're not really.

And also, I have tomorrow off, but there's still hot as fuck drying equipment all over my apartment, and it's ninety degrees in here, and I can't play PC games without tripping the breaker. So I guess I'll just sit alone in the heat and be miserable.

"Good news: lots of learning points. Bad news: I feel like a fucking idiot."