Tuesday, August 15, 2017

Anesthesia Oral Boards

I recently received a comment request and was surprised because I have not posted on this blog in such a long time. The comment came from someone dating a physician. Her sincere concerns caused me to reflect on the years of training and the challenges therein.

I felt impressed to look at my blog again.

I found this post buried from years ago.

Oral Boards.

Two words that can strike great fear in one's heart, whether in anticipation or in recollection. While my husband was studying for his oral boards, he actually developed some sort of weird auto immune disease. It quickly disappeared after he completed them. It was such a stressful time. He studied every minute possible, he met together with other residents and studied late into the night, he set up practice boards with multiple faculty members, and he was continuously listening to oral board review CD's any time that he could. We went to visit family one Sunday and he, (as well as the rest of us in the family who were sitting in the minivan during the drive), listened to his CD's there and back.

I thought about writing up a synopsis of what happens during an oral board exam but found a great description here: Advice for Passing the Oral Board Exams in Anesthesiology. Please note that this advice is specifically for Anesthesia Oral Boards.

Here are the main bullet points that are made on the website referenced above:


1. Read Miller's Anesthesia cover to cover.
2. Be well trained. Work hard during residency. Do challenging cases, study and read about those cases before and after the anesthetic. Attend the department lectures, and mortality and morbidity conferences.
3. Download and memorize the algorithms in the Stanford Emergency Manual/Cognitive Aid for Perioperative Critical Events.
4. Set up mock-oral practice exams.

Some interesting advice from the website:
1. Try not to ask questions. Use your time to answer questions.
2. There is no one right answer for most clinical scenario questions. Be prepared to justify who you chose the plan you chose.
3. If you don't know an answer it's better to say "I don't know" than to blunder and guess.
4. Make eye contact with the examiner throughout.

It is incredible to read through the example of cases and all of the possible follow up questions involving preoperative management and intraoperative management.

There is great information on the ABA website as well, including videos of what to expect during Oral Board exams.

Phew. So grateful my husband go through that. It was stressful for me just to read all of this information.

Good luck if you are currently preparing to take your oral boards!

Monday, December 22, 2014

sweeping the floor... the huge floor

After fellowship my husband and I moved to a city where the cost of living is much less than anywhere we've ever lived. The housing, food, gasoline, soccer camps, music lessons, utilities, everything is cheaper... not to mention we hardly drive much because it is a smaller city, so we don't need to gas up like we did before. The low housing prices meant that we could purchase a large home for our growing kids for an extremely reasonable price (to be fair I should mention that we are coming from Seattle, where real estate is ridiculously expensive, so our perspective is probably a little warped). Anyways, we found a pretty house with gorgeous dark wood plank floors.

Of course I fell in love with the floors.

But, these floors cover nearly half the house, large living area, dining area, kitchen, hallways, sitting room...and they need to be swept often, (like every few minutes), because one can easily spot every tiny little spec that has fallen on them. Of course I don't sweep that often, so by the time I sweep (usually within 12 hours or I start going crazy) it takes a long time to sweep all of the floors.

Many people have asked me if we plan to hire a maid now that my husband is done with training, and maybe because they notice the tiny little specs accumulating on my floor. Of course I've always been repulsed by the idea of hiring someone to clean my house - I have issues, I guess. I hate the idea of people cleaning up after me and always have. Plus, I've always held firm the idea that it is my responsibility to teach my kids how to work, and what is better than for them to help me clean our house? I can't think of anything better... since we don't have a farm.

Today I had to sweep my floor. It was filthy. Dust flew everywhere. I had waited for days to sweep because I was sick and then two of my kids were sick. By the time I had finished sweeping, I had completely rationalized the idea of having someone come clean my house, and in particular, my floors. My reasoning included ideas such as how I should be sympathetic to people who desperately need cleaning jobs, who were not able to attend school but are hard working individuals that need employment; how good it would be for our small city's economy; how I could spend so much more time volunteering in the community if I didn't have to spend so much time cleaning my wood floors.

Holy cow.

Now that I've thought through it and written all of this down, I've changed my mind, I've decided to teach my 7-year old how to sweep, and how to sweep well. This will be his new chore, every other day, required for his weekly allowance. I've created a new job chart for my kids in general. I desperately want to move back into our small and manageable house where we lived during medical school. Of course my husband and family like this house, so they will have to help me, daily, to clean it.

It's amazing how powerful the brain is in our decision making and eventually the choices we make. Sometimes I wonder why my brain is so weak, It must be because Christmas is only a few days away. Yes, stress leads us to make crazy decisions.

Luckily I thought this one through before I made any drastic moves.

Tuesday, November 11, 2014

and now it's been 3.5 months...

Okay, I have to be honest, life after residency seems.... uh... very... similar.

A close friend had warned me about that years ago, but of course I shook off the thought of it... especially since my expectations of life after residency were literally carrying me - at times - through the experiences of residency.

But to be honest, I feel certain that much of our survival during residency was possible because of our faith. I had an incredibly optimistic view of life. Maybe it was a way for me to be compelled to pray, to be humble, to seek strength from God, and to move forward in faith. Lately many of my friends have started questioning our faith. Because of all that I have been through with the Savior during the last five years of residency and fellowship, I feel more certainty than ever.

So, would I want to go through it all over again?

Yes, definitely.

Could I have done it without my faith and hope in and love for my Savior?

No, definitely not.

There are a lot of questions about the LDS faith. This is a thoughtful explanation about garments worn by some Latter-day Saints. There is so much meaning and depth in thoughtful, regular worship. I cannot imagine going without all of those moments of introspection and supplication to the Lord, contemplation on scriptural teachings, and feelings of peace, strength, love, hope that I received during the darkest and loneliest moments.

But, I am grateful it is over?



Tuesday, July 29, 2014

a memorable move

One week. It's been one week since we moved.

I will never forget the experience our family had while moving from residency to my husband's first "real" job. After staying two and a half weeks with my in-laws, (which was honestly like *heaven* - my mother-in-law cooked for me and even did my laundry a few times, kept my kids happy, fed them while I slept in... I know!), a huge going-away-party that a friend planned for our family, (lots of hugs and sad goodbyes), one week at the beach with my family while my husband finished his fellowship, (also deeply relaxing with long runs along the empty beach, my sister's baby to cuddle with, delicious meals made by my sister, more sleeping in while my sister fed my kids breakfast in the mornings... I know - I love her so much!), three days of driving 18-hours (my husband in his car with two kids and me in my van with two kids), four days at my husband's family reunion, (lots of little second cousins pulling my kids in different directions which allowed for fun adult conversations, lots of hugs, surrounded by people who love us and care about our family), and finally we arrived to our new home.

It was exhausting! We felt like sleeping for a month. But, within two days my husband's grandfather passed away (who lived just two miles from our new home). We spent time with him (my husband would not leave his side). We visited with family. We cried. And we tried to find time to unpack. We finally attended church after five days here and our kids were delighted to meet some friends.

One month. It took us one month to move 18 hours away.

I hope this is the city and home that we choose to live in - forever. I honestly never, ever want to move again.

I'll post some pictures eventually. But right now the house is pretty empty. And it will stay that way for a while. My husband's first pay check doesn't come until the end of September, and we are just barely out of residency and fellowship - the financially tightest five years of our lives.

But, but, we survived those five years. We are still married. And, we are still happy. Very, very happy.

Monday, May 19, 2014

the last 9 yards... I mean, 9 weeks...

Everyone told us this would be the hardest year.

Well, that's not exactly true. Everyone said that the last year of residency would be the hardest. Apparently we made it through that year fine though. Well... that was actually a very trying year that I have mostly tried to forget... but somehow we dug deep enough to invite another year of training. Maybe we wanted to prolong that last year of training? - or double it? Revel in it? Whatever our reasons - or lack of reasoning - we added another year. and my husband is doing a fellowship. And right now, only nine weeks until he is completely finished, things are getting interesting.

We had no idea it could be this challenging.

Mentally. Financially. Emotionally. Physically. Intellectually.

Ok, let's start with the financial aspect of it, (because we all know that financial stress messes with and exacerbates all of the other things listed above).

This is an expensive year. Extremely expensive. We, (well, I - my husband does not agree) should have applied to at least two credit cards last year, when our credit scores were awesome.

We should have sat down and looked at all of the projected expenses for the year. The interview costs (ohmygoodness!), the expenses of the Boards (books, travel, $2,000 exam fee, etc.), moving costs, attorneys fees, licensing fees (how many of these are there??), etc. etc. etc.

Somehow we should have foreseen that our van would need over $5,000 in repairs this year. We also should have predicted that our family would require over $2,500 in dental treatments - (what??? - I know!) We should not have put our two older kids in ski school.

It feels like we are on a roller coaster, but not a very fun one. This roller coaster just continues going down a steep drop. And while we know there is a bottom to our reckless and exhilarating drop, it is not an enjoyable feeling as we now keep waiting and anticipating to hit a curve or a bend... or something - just so that we can take a breath and recoup.

But it doesn't come.

Nine weeks.

So that is my advice. Get an extra line of credit before the last year of training. One with no fees for a year. Or something. Just in case. Maybe you won't have to use it. It'll just be there for you - in case.

The other night my husband said, What are we going to do? I said, Let's just try to be nice to each other.

So we are being nice. And that is good advice too for the last year of training. I think. There is so much going on inside, so many worries, thoughts, expectations, etc. Yes... just be nice to each other.

Monday, December 30, 2013

"...we stay in... we keep working... we keep believing..."

My emotions are bundled up and overwhelmed with worries about finances... again. It is amazing how immobilized I feel when I start worrying. I can hardly function. I barely made it out of my pajamas today before my husband came home - from a 14 out of 24-hour work day. I'm sure there is a medical term for my inability to function... but I don't want my husband analyzing me so I don't think I'll ask him about it.

After I realized how tied up I was (and finished cleaning the entire house), I started to read. I grabbed every book that I could find that I had started reading in the last few months but never finished (it's a bad habit...). I let my kids build floating contraptions, make bubbles in the bathtub and turn on a huge fan to simulate an ocean storm. I let them play football and soccer in the house. I served leftovers for dinner... and cereal for breakfast. It was not a day I would like to brag about - ever. I just needed to read - to immerse myself - to distract myself.

Then I read these words: "We can't worry about what might have happened. All we can do is keep looking." (In 'Because of Winn-Dixie' - a book my daughter told me to read because she liked it so much).

Suddenly I was reminded of how destructive worrying is, what a waste of energy it truly is, that I can actually choose whether or not to worry, it is an action, an activity. And I suddenly felt calm inside. I decided to stop worrying. I knew I just needed to keep moving, continueing to work to take care of my family, play with my kids, be happy, have faith, and stop wasting my time and energy worrying about the future.

This is a neat video... I really like the lessons at the end.

"We stay in, we keep working, we keep believing, keep trusting, following that same path and we will live to fall in His arms and feel His embrace and hear Him say, "I told you it'd be ok, I told you it would be all right." 

I just love that.

Thursday, November 14, 2013

choosing the next adventure...

The other day I was reading a continuing education booklet for a local community college.  (It was a little slow... I was working at a nearby high school as a general sub (not a teacher).  It is an on-call position that is very flexible and allows me to make a little extra money while my youngest child is at preschool during the day... and sometimes my responsibilities are not too demanding of my time or focus... anyways, I can't handle sitting still without something to read...)

I found this thought as I read through the booklet:  "The happiest people may be those who've realized that it's worth seeking out novel experiences that promote growth even if they present a challenge."  This thought was part of a brief article titled: "Recipe for Maximum Happiness: Feed your curiosity, meet a challenge, pursue your purpose."

As I read this thought, (amidst our current discussions surrounding which job my husband should take after completing his residency and fellowship this year), I was moved deeply.  I consider myself a very capable person (okay, only with regards to handling challenges and pursuing difficult experiences... which often are because of mistakes I've made, or are due to my totally unrealistic optimistic attitude about, well, everything...).  However, I also really like stability and really, really dislike surprises... and change, in general.  My attempt to control the present situation, to methodically reason through pros and cons of our options, to make a good choice, is somewhat comical. 

The day that I read this booklet I was praying hard, fasting, and completely focused on receiving an answer.  It was interesting to me how this thought impacted me.  I felt strongly that I should not be so resistant to change and unfamiliar territory, that I should focus more on the needs of others rather than my own, that I should be less prideful.  These feelings were powerful, and changed me enough for me to open my heart and accept new ways of seeing the needs of others and the potential experiences for our family, post medical training.  All along I was seeking an answer from God, I wanted to be told what to do so that I could know with absolute certainty that everything that would happen (good and bad) was "meant to be".  However, it quickly became clear one day after fruitless attempts to receive an answer, that my life is like a Choose Your Own Adventure book... which doesn't bode well with my  strong inability to make decisions, in addition to my tendency to endlessly question every decision that I (ever) make in life.

I know how important it is to "disrupt ourselves" often, that this creates valuable opportunities for learning and growth.  But, it is so hard for me!  I love how my kids just attacked this hike (pictures), exploring without fear, even climbing down "the Crack" to shimmy their way down in the dark slot canyon.  I hope I can strengthen my adventurous side... maybe I can borrow some from my kids.

Wednesday, October 30, 2013

interviewing for a job... finally...

Interviewing for a job - post-training - is not quite what I thought it would be like.  Of course, I didn't join my husband on any of his previous interview trips - those for med school, residency, fellowship - so much of this is very new for me.

My husband applied to many places... but let me just mention here that, in particular, the places on his list seem to all have a few common themes: they have at some point made their way into his Bicycling magazines, their population is less than 100,000 people, and they provide a plethora of outdoor hobbies and adventures. 

The first interview trip was very stressful for me, for many reasons:  leaving my four children with multiple individuals to scramble through their hectic schedule; I actually had to go to a mall to look for an outfit that I could wear to the dinner with spouses (I do not enjoy the mall, to put it lightly); watching myself spending money (we did not have) on flights, hotels, rental car, food on the go, etc. - not to mention my outfit at the mall.  I was also constantly transporting my husband from one location to the next and had to be close by when he needed the car.  (In addition, during the trip I was finishing up writing three grants for my kids' elementary school, researching neighborhoods, crime statistics, schools, etc. because I had procrastinated just a bit.)  I came back completed exhausted, grateful that it would be the one and only interview trip with my husband.

But, the next interview trip came along quickly.  My husband promised me a beach house (ya right, but it was a sweet gesture) if I came along - because I told him I would only be joining him for one.  This trip was nice, however (yes, I gave in and went).  I took along a book.  I already had my outfit (down to the earrings, shoes, hairstyle) planned out (it was the same as the first interview - exactly).  I knew what to expect.  I was ready for all of their questions.  I was more relaxed.  I knew exactly what I needed to do, and how to do it.  It was all very nice.  I even went trail running while my husband was interviewing (an important part of my "research" of the city).

We just got home late last night from the second interview trip.  Things seem crazy now.  Now that we have choices.  We would have been happy with one choice, but now we are completely confused  and unhappy with two choices staring at us.  Interesting.  Sometimes I feel so mixed up inside and start worrying (much more than I think is healthy) about making the wrong choice.  Other times I stand back and think that it is not such a big deal - we've always loved where we have lived and found wonderful people around us - and we can always move again.  Why does it feel like such a huge deal to actually accept a job, now that my husband is almost finished with his medical training? 

An extra little tidbit of information that seems important to include: my husband will not start his job until late this coming summer - meaning that all of the interviewing, deliberation, praying, intense discussions, stress, does not mean that we are moving right now.  It does mean that we need to be making the decision... but we are discovering that this is difficult with older children... especially since the anticipation for them is just as bad as the actual move.  It seems to be making our 11-year old son crazy.  He does not want to leave his friends. I think somehow my husband and I need to figure out a way to stop talking about where he will take a job and the fact that we will be moving.  Completely stop.  Until my husband's start date is a week away, then we will bring it up casually, quickly move and then be done. 

The poor kids.

So maybe this decision is a huge deal, maybe we do need to make "the right choice", because I can't imagine doing this to the kids again... ever.  We need to stay somewhere at least 14 years - that is when our youngest will turn 18-years old.  14 years.  Anyone can survive anywhere for 14 years, right?

Thursday, August 8, 2013

food, France, and finances

It's been more than three months now since I began eliminating processed foods, sugars and breads from my diet.  The first few weeks were the most difficult (and, honestly, it is still challenging sometimes)... but the experience overall has definitely been worth it.  I have felt empowered and healthy, truly healthy, inside.  I have lost inches, pounds, and everyone tells me I look much thinner and healthier.  I had no idea that the effects of a healthier diet would be so noticeable, for me on the inside as well as for others on my outside.

Recently, (as mentioned in the post below), I went home to visit my parents for a few weeks.  It was a great respite from the exciting spring we had as a family, being asked by our landlord to move and then told we could stay for one more year (after I packed up half the house).  I also volunteered to be the treasurer for my son's select soccer team (26 boys) after a long deliberation by my son about whether to play select or premier soccer this year.  I also volunteered to take charge of fundraising for my children's elementary school as a member of the PTA executive board, and began attending meetings and trainings.

(My little 4-year old niece took this picture of me during our family reunion.  My face/hair looks crazy but it shows my figure a little bit...)

After my husband took his boards and began his fellowship, I returned home with my kids... against my better judgement, digging my heels in, but fully recognizing that I needed to return to "reality" and my husband (I missed him so much!!).  What I didn't expect was the realization that I had charged an enormous amount of money to our credit card while away.  Our transmission burned up during our 20-hour drive and we spent almost $5,000.00 replacing it in our 2004 Odyssey (I know - not cool, or probably wise!), and because my husband had no income during the month of July, (the fellowship program gave the fellows a month off in order to study for their medical boards), I used our credit card for the month... to live.

The efforts of the last three months to figure out how to overcome my (previous, deeply set) emotional eating habits, to intentionally feed my body and soul, to master my cravings and irresponsible eating, to truly enjoy food but not be controlled by it, all suddenly seemed irrelevant.  The financial stress that quickly crept over me and throughout my being gradually took over during the first two days home... and I began to eat.  Granted I was eating healthy... peanut butter with apples or bananas, walnuts and strawberries on red leaf lettuce, brie cheese on healthy crackers, eggs with tomatoes and pepper jack cheese, homemade black bean burgers, delicious brownies made of walnuts, oatmeal, dates and cocoa, fruit and vegetables, etc. For two days I ate... and ate and ate.  Yesterday by 4:00 pm I was absolutely sick.  I felt awful.  I realized that I had allowed myself to give in to the comfort that food offers, the addictiveness of eating delicious food to satisfy stress and the bodily cravings associated with dealing with stress.

This morning I grabbed a book that I borrowed from my mom's bookshelf when I was there: French Women Don't Get Fat, by Mireille Guiliano.  (I have an fascination with France and always have... I studied French in college and have dreamed of going there (or living there!) ever since.)  It has been delightful to read.  There are so many wise tidbits... like:

To be successful, "...you have to be ready to embrace pleasure and individual happiness as your goals."
"A French woman's secret is mainly in her head.  It is one thing to identify your offenders, quite another thing to manage them."
"Novelty is a powerful distraction.  Choose quality over quantity: pick things in season."
"A walk not only uses calories, it can be wonderfully meditative, clearing your head and making you less vulnerable to eating for psychological comfort."
"Deprivation is the mother of failure.  Any program that your mind interprets as punishment is one your mind is bound to rebel against."
"He (her physician) was telling me to be the master of my pleasures as well as my restraint."
"Three months of discovering new things and getting to know your body better is a kindness to yourself that will continue to be repaid for years to come."

This is one of my favorite parts of the book so far:

"At least half of our bad eating and drinking habits are careless, they grow out of inattention to our true needs and delights.  We don't notice what we are consuming, we are not alert to flavors--we are not really enjoying our indulgences, and therefore we think nothing of them and overdo it.  Perhaps you have given up caring about fashion.  Or trying other new things?  It maybe easy for a wife, mother, and full-time worker to neglect pleasure; perhaps a part of you even thinks it's selfish.  But you must understand there is nothing noble in failing to discover and cultivate your pleasures... You owe it to your loved ones as well as yourself to know and pursue your pleasures.  And since everyone's taste and metabolism are unique, you must pay attention to yourself-- to what delights you-- so you can tailor your system and preferences.  It's a lifelong commitment, but it promises a lifetime of good health and contentment."

I am only half way into the book but I felt that I had to share some of these tidbits that inspired me to step back and evaluate my current psychological health and make a plan for being successful in my desire to live healthily, happily and fully. 

Sunday, August 4, 2013

tests... tests... tests...

Okay, studying for the MCAT, medical school exams, residency practice exams, etc. have all been stressful... well, okay, sometimes it has totally been the pits.  But I had no idea how stressful studying for The Boards at the end of residency would be.

Weeks before my husband was scheduled to take his board exams, I left town with my four kids... straight to my parents house for a few weeks to let my husband study full time.  I know he appreciates having fewer distractions.  (I also enjoy being separated from the stress.)  But it is hard to listen to him from afar, to not be there with him, encouraging him, feeding him, comforting him, etc. during such a stressful time.

I sure hope we don't have to repeat this experience again next summer.  Though, I guess he'll have to take additional boards after his year of fellowship... my goodness! 

I guess it never ends in the medical field - they have to maintain their board certification status by passing boards every ten years, I believe.