Tag: anxiety

these are my confessions

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Anyone else’s mind jump straight to the Usher track whenever they hear the word confession? No, just me? That’s cool. I’ve come to terms with my embarrassing and unwavering love for Usher during my junior high years. It’s fine.

But on the real – I thought it was time for a life update since it’s been a minute. I started sharing my journey through medicine, and life in general, on here and Instagram because I wanted people to feel less alone in their struggles. In this age of social media, it’s easy to fall into the mentality that everyone has their life together except you. But that’s obviously not the case – we just choose to present our best selves to the world. And on the surface there isn’t anything wrong with that as long as we can remember that there is so much else going on that is not being shared. But in the past couple months, since finding out I failed step one again, I’ve started to feel like I’m folding into myself and only presenting the highlights of my life. And while I don’t owe anything to strangers on the internet, I feel it’s important for me that I continue to present myself honestly.

Since December I’ve hit one of the most severe bouts of depression I’ve had in my life. I’m pretty sure I’ve struggled with both depression and anxiety for most of my life but wasn’t clinically diagnosed until starting medical school. Stress has always been a huge trigger for me and obviously failure, and step one in general, is stressful. Having been through similar, but less severe, episodes in the past I tackled my depression head on with the things that have usually helped me. I continued taking my medications, working with my therapist, etc. I put away my books and I traveled. I spent time with loved ones and my kitten. And I convinced myself that I was feeling better and dove back into studying as the new year began in January.

But I wasn’t okay. I was struggling badly. I couldn’t focus. I was irritable. I had so much trouble sleeping. I was nauseous all the time. I hand anxiety attacks weekly that were almost as bad as the ones that initially drove me to seek help. So I sought council from those I trust and one of the deans at the SOM recommended that I get tested for learning disabilities in case that there was something making it harder for me to succeed and adding to my stress. I realized that it was important for me to set my ego and internalized stigma towards disabilities aside and truly find out if there were accommodations out there that would help me with both my studying and in my exam taking. It took months before I was able to find someone who accepted my insurance and saw adult patients but I finally got an appointment about a month and a half out. Those of you becoming psychologists, thank you, you are so needed.

Around this time, 45 also started his presidency in the United States. I think it’s pretty clear from my previous posts where I stand politically. The US has always had a dark history when it comes to marginalized peoples but something about the blatant disregard/outright support of the xenophobic rhetoric during the elections made the inauguration sting so much more than I had anticipated. Every executive order and tweet and confirmation has truly felt like a personal assault. It’s taken weeks for me to be okay with the fact that my resistance, at this moment in my life, is almost always in pursuit of my career. I will continue to do my best to be aware. To understand the struggles of those who look and live differently than I. To educate and have the difficult conversations. To organize. To put my body on the line as often as possible when my sisters’ and brothers’ human rights are at risk. But for the most part – my resistance is hours and hours of studying to pass an exam so that I may advocate and care for my patients. And for now, that has to be enough.

Meanwhile, I did my best to continue studying. I searched online for tutoring programs for medical students that worked through video chat. I wasn’t ready to pick my whole life up and move to another state again, as I did when attending Wolfpacc in the summer. It was clear that I had made the most progress in my studying in the months after I had returned home and worked hard on my own. I’m certain that the most helpful aspect of being at Wolfpacc was being in a supportive environment surrounded by people who truly understood the struggle but I did also miss the tutors and the structure they provided. I also missed having someone to run my study schedule by to ensure that I was as effective as I could be in my studying. I missed doing questions with a tutor and running through my thought process with them so that I could identify holes in my knowledge. And that’s when I stumbled across Med School Tutors and was immediately intrigued. I had the opportunity to do one-on-one tutoring from home with someone who would also help me create a schedule that worked for me. It sounded perfect!

Now, I don’t think that this is something that necessarily everyone studying for USMLE needs. But having been at this for so long, I knew I needed more encouragement and reassurance this time around and I’ve found exactly that in working with a tutor through MST. Their entire team has been so incredibly supportive of my goals. The thing that I love most about MST is that they share my values. When I opened up to them about how much I had been struggling, they immediately reassured me that taking care of my health, both physical and mental, is the priority. They helped me rearrange my tutoring schedule at no additional cost to work best for my needs. Having a group of people who’ve essentially been cheering me on through the struggle of doing this for a third time has been such a blessing. If you do decide to check out MST, please cite me as your referral. This post isn’t at all sponsored by Med School Tutors but I do want to disclose that I will get a free hour of tutoring if you decide to work with them.

While struggling through all this I started falling victim to some really serious negative self talk and began to struggle with so many of the things I often warn you all about: feeling shame in the face of failure, constantly comparing myself to others, etc. and it started to take a serious toll. Part of the ugliness of depression is that it’s hard to separate when your thoughts are due to the illness versus when you’re actually right in your introspection and reflection. It’s taken me some time to be able to separate those two things and journaling daily has really helped me with that. I’ve been drowning myself in self care & self love and really doing my best to replace the negative self talk with positive affirmations.

I’ve taken the last couple weeks off from studying and really focused on getting back to feeling like myself. In my appointments with the neuropsychologist, we ruled out any learning disabilities but in talking to him about everything I’ve been through and am going through the past couple years, I realized that my depression and anxiety haven’t been managed as aggressively as they should’ve been. My primary care physician had been treating me until now and she isn’t the greatest when it comes to mental illness. (Another reason why I continually come back to a career in family medicine. We so badly need primary physicians who can provide holistic care. Shout out to all my future FM docs! I’ve got so much love for y’all). While talking to a close friend about this, she asked me why I hadn’t sought care from a psychiatrist over the past couple years that I had been dealing with my undertreated depression and anxiety. And I had no real answer. I later realized that it was because I, someone who constantly advocates against mental illness not being a true disease, had been downplaying my own mental illness for years. I hadn’t sought care from a psychiatrist, knowing that my PCP wasn’t doing a great job treating me, because I didn’t think it was that bad. I expected myself to pick myself up and just brush it off. I didn’t want to be someone who had a psychiatrist, and thus, label myself crazy. Why is it so much easier to show others compassion than ourselves? If I’d sought treatment for my mental illness as I’d encourage my patients and loved ones to do, the past couple years would have been so much easier.

So in the past few weeks I’ve talked to therapists and psychologists and psychiatrists and finally feel like I’m getting the care that I need. And while I’m still not feeling 100% like myself again, I’m finally caring for myself as I’d want my patients to care for themselves. I’ve spent a lot of time protecting my heart from those who try to dismiss my experience when I share my struggles and recognizing how strong I’ve been for so many years. I’m spending the rest of this week doing things that truly bring me joy, surrounding myself with the incredible people who have held me up in these difficult times often without even knowing it and simply finding gratitude in the little things.

I found out last week that the NBME accepted my appeal to expunge my score from my second attempt – you can read about my test day experience here. That news really helped restore my faith in ‘the system’ because I’ve recently been feeling like I’ve dedicated so much of my life to a field that doesn’t truly care about its people. I also found out that I was accepted to WISE’s Muslim Women’s Summit later this year, which will help me become a more effective activist and advocate. I’m still figuring out the details of my trip to the east coast but give me a shout if you’ll also be at the conference!

I know that I have what it takes to pass this exam and have an extraordinary career in medicine. But I’m still learning and unlearning what it takes to truly care for myself and be my best self. Thank you for your company on this journey.

on mental illness in med school

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As mental health awareness comes to an end, I wanted to address something very close to my heart: mental illness and reducing the stigma that often comes with it, especially in health care. I’ve suffered from depression and anxiety for, well I don’t really know how long but I was officially diagnosed with both during my first year of medical school. It was a really difficult time for many reasons and I just couldn’t deal with it on my own anymore and decided to get help. I was really hesitant to do so at first because I was worried about being perceived as weak, that I couldn’t handle medical school and the challenges that come with it. It’s so, incredibly, heartbreaking how many health care professionals we lose, both practicing and in training, to suicide each year. We’ve made progress on dealing with the lack of support for our community when it comes to mental health but we still have so much work to do. So much of why I want to go into academia is to change the way we educate and train our physicians, to do it in a way that doesn’t require us to rob them of their humanity, compassion and ability to empathize with others.

Before I get into how I’ve dealt with both of these diagnoses while in medical school, I want to address how absolutely ridiculous it is that this stigma exists at all but especially in the field of medicine where we know and understand the pathology behind mental illness. We know that there are actual problems in the balance of our hormones. We know that it’s not just laziness or something you just ‘push through’ or ‘get over.’ So the first step in dealing with depression and anxiety in medical school is accepting that there is no shame in having a mental illness.

Think about it this way: anxiety and depression are essentially like having allergies, your body is overreacting to something it perceives to be threatening when it’s not really that bad. With allergies, some people’s bodies think peanuts are the equivalent of poison when there is nothing inherently dangerous about peanuts – as long as you’re not allergic. I’m eating a peanut butter granola bar from Trader Joe’s as I type this and I’m not going into anaphylactic shock – because my body doesn’t perceive peanuts as a threat but for others, it most definitely is. It’s the same with depression and anxiety – episodes can be triggered by things that may not seem that bad to people who don’t have mental illness. Some people’s bodies do not turn on them when they have to take an exam, or have to speak publicly or for no apparent reason. But I obviously would never judge my friend with nut allergies for needing an epi pen or avoiding triggers, right? So why do we do that to ourselves and each other when it comes to mental illness? Let’s just make a commitment to not think of it any differently – when it comes to us or to our friends or our patients.

So now for tangible advice and steps you can take if you are dealing with depression or anxiety – and please keep in mind this advice is from the perspective of someone who has dealt with these issues, not as professional medical advice.

  • Find a therapist you trust and feel comfortable with. This can definitely be tough because it takes a certain level of comfort and trust to be able to discuss what you need to discuss with a therapist. I would recommend starting with counselors at your school if that’s an option since they usually understand at least some of the struggles students face. And I know that it can be exhausting to jump from therapist to therapist and repeatedly telling your story to a stranger but it’s worth it when you find someone you can really talk to. Yelp is a surprisingly great place to read reviews for various therapists. And it’s a good idea to go into each session with an idea of the topics you want to discuss and issues you want to work on. This link has really helpful advice on how to approach your first session with a therapist.
  • Don’t be afraid to try medication. Like we talked about above, there’s no shame in your Zyrtec game and there shouldn’t be with Prozac (or any other medication) either.
  • Prioritize your health and well being. We all know that we should take care of ourselves but how many of us actually prioritize doing so? Because we need to, especially if you’re dealing with mental illness. I find exercising regularly to be really helpful and I’ve recently also started doing yoga (at home with Yoga with Adriene), which has also been great. Prioritize getting enough sleep, especially in the first two years of medical school when you have much more control over your schedule. Pulling all nighters is not a good way to learn and you need sleep to be able to retain everything you spend hours studying. I also find that limiting my caffeine intake really helps keep my anxiety symptoms away so I’ve tried to stop drinking coffee on and off for the past few years. Try limiting it as much as you can! I’m not a fan of cooking so eating healthily can be difficult but I try to buy preprepared frozen meals made by companies like Evol Foods and Sweet Earth Foods because they provide healthier options. And if, even for a second, you start feeling ‘selfish’ for taking care of yourself remember:

    ‘Caring for myself is not self indulgence, it is self preservation and that is an act of political warfare.’ – Audre Lorde

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  • Get a furchild. This obviously isn’t for everyone but have Kohl in my life has made the struggles of 2016 so much easier to deal with it. There’s something about a tiny kitten purring on your lap that makes you feel like it’s all going to be okay. So if it’s something you can do, consider adopting a kitten or puppy. It’s amazing how they just know when you’re not doing well or need extra cuddles. He’s been the source of my sanity through studying for remediation and boards.
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  • Spend time in places that inspire you. This can be as simple as going to your local coffee shop to study or planning a weekend getaway with your significant other/a group of friends. Changing where you are makes coming home feel so sweet and reenergizes you to continue doing what needs to get done. And making time for fun things is so important – you need it to recharge.
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  • Work hard when you feel good. The thing with both depression and anxiety is that they can sneak up on you. You can have an objectively good day and still feel completely miserable. So in a way, it’s important to ‘prepare’ for these episodes by being extra productive when you are feeling well. That way if you have an off day, you won’t fall behind because you prepared for it. I always have a game plan for studying for each block but because I know that some days are going to be better than others, I plan goals for each week (rather than each day). So when I have a day when I’m feeling down, I’m not really falling behind as long as I spend the day caring for myself and getting recharged so I can tackle tasks the next day and still stay on schedule. Having this flexibility has been really great for me and also reduces the guilt of ‘doing nothing’ on the days when I really can’t.
  • Spend time in service of others. There’s something so incredibly fulfilling in giving your time or skills to help others. If you’re in healthcare, a big part of why you’re here is because you have that innate need to be in service of others. So stay in touch with that by volunteering with your local free clinic or mentoring youth from underserved communities. Doing these things also really helps bring your purpose back into perspective. It helps you remember why you’re spending so much of your time studying and making so many sacrifices.
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  • Don’t be afraid to reach out to your classmates or friends. I can’t tell you the number of messages and comments I read every week from others in this field who share that they too are dealing with depression, anxiety or both. Don’t feel obligated to share this part of your journey if you don’t feel comfortable doing so but please know that you’re not alone. And if you do decide to share, realize that your recovery is going to look different from others’ so try your best not to compare. In this age of social media, it’s easy for us to think that everyone’s life is so much easier and better than ours but realize that most people just show the pretty parts. We’re all going through difficult times.
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  • Be kind and patient with yourself. This is something that I still struggle with. It’s so easy to fall into the trap of comparing yourself to others who seem to be much more productive or being angry with yourself for ‘being lazy.’ But realize that type of thinking is not productive in any way. You’re only prolonging this episode of deeper depression or anxiety by doing so. Your body is clearly telling you it needs a break or a change so spend an hour or so taking care of yourself and come back to your work. Treat yourself with the same compassion you’d show your patient who is struggling with similar issues.
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So much of why I started this blog and started speaking about my journey on Instagram is because I did not want anyone else to feel alone in the struggles that come with this journey. You are not alone. You deserve the best out of life and while we make many sacrifices on this journey, you should not sacrifice your health and well being in order to care for others. It takes some courage to seek help and take the steps towards recovery but it’s well worth the effort. You deserve a life where happiness is the norm, not the exception. You deserve a life that does not feel like a burden. If you won’t do it for yourself, do it for your future patients because they deserve a healer who has spent time healing themselves.

edit: here is an additional resource by zencare on mental health while in college.