Clinical Guide The Nerd's Guide to Pre-Rounding Table of Contents Part 11. Morale Management There’s three elements: time, your mental/emotional health, and your physical health. Time Management - The Crucial Survival Skill. At my orientation, Ellen Hughes told a horror story about being advised before her clerkships to buy 30 pairs of underwear, because she wouldn’t have time to wash them! I was relieved to find that I had time to wash my underwear. And even my socks. Even during inpatient rotations, you will usually have your weekends off. My advice: USE THEM. Use your weekends to at least do your laundry and buy food for the week. I also adopted a "same day" policy on paying my bills—in other words, as soon as I opened it, I wrote a check and dropped it in the mail. Doing chores like this, esp. when you’re tired, is a pain. But it keeps the work week saner. It may suck to spend part of Saturday at Costco, but it sucks more to get home at 8 p.m. after a long day and have nothing to eat. If you’re already on top of stuff like this, breathe easy—you will probably be able to maintain that. If you’re not, getting more organized will help you stay sane. Also: Many people post-call have an adrenaline surge going, and may be tempted to go out with friends, etc. after work. This may be an act of resistance, fighting the feeling that med school is "stealing" your life away. I STRONGLY RECOMMEND the following activities, post-call: Sleep. If you don’t, it’ll catch up with you. Your cosmetologist will thank you later. Mental and Emotional Preparation You may be entering third year feeling pretty good, pretty confident, pretty together. Or you may be feeling very anxious. Either way, it’s wise to prepare for emotional turbulence ahead. It’s better to plan for needing extra support, and find you don’t need it, than to go in thinking you’ll be fine, and then finding out the hard way that thanks to unnoticed depression or stress, you’ve been a grouch and alienated people around you—including your evaluators. Marshal support. There are various ways to do this. In my case, my partner was more pro-active in "battening down the hatches" in preparation for third year than I was. He helped me get my clothes and gear together, and for the first few weeks he packed lunches for me. (I know, I know, if I weren’t already married to him, this would be a reason to do so.) If you have a partner, I don’t necessarily suggest you find a way to get him/her to make you lunches, but you might warn them that the months ahead will be stressful and that their understanding and support will be especially important to you. And, regardless of whether you’re single or in a relationship, you should warn your family and non-school friends that you are entering a stressful period and will need extra support. If they want to see you, maybe they should drive to your place - you might be too tired to travel to see them. Heck, they might even take you out to dinner. (Well, it can’t hurt to ask; show them this guide and tell them it’ll get you into AOA.) Likewise, they shouldn’t expect that you will be instantly reachable by phone. The non-school sources of support become especially important since you’re unlikely to see your classmates much, and when you talk to them, they may be as stressed out/tired as you are. On the other hand, many students mentioned that third year gave them a chance to bond with classmates they barely knew during the first two years, who became good friends. Still… Third year can be isolating. Many students are surprised to find they feel isolated in third year, despite being surrounded by people all day long. You won’t see your class pals on a daily basis anymore, except if they’re randomized to your clerkship site with you. And even though you’ll have residents around you on your "team," you may feel obligated to keep your "stage face" and not let loose about how stressed out you are. In fact, they may be the very people about whom you need to vent! I spoke to one student who said that in hindsight, she wished she’d signed up for the student well-being program support groups from the outset. At the very least, be aware of this program, run by Dr. Rachel Goldstone. Many students find having a place to vent during the first months of clerkship is very helpful. In my own case, I prepared for the emotional stresses of third year by visiting Dr. Lynn Shroeder at student health psych services. I told her about my history of depression and my worries that clerkship stresses might get me down. She took a full history from me, and we planned for me to watch my moods and to come back if it felt like I was getting depressed, so that I could discuss treatments, including anti-depressants. She assured me that my medical records at SHS were completely confidential. As it turned out, I was able to manage my moods fine, but it felt good to have a back-up plan. Physical Preparation (Cue "Rocky" theme song.) Regular exercise is possible during third year—you may not be able to go three times a week, but even on VA surgery I was able to go 1-2 times a week. If you’re the kind of person who likes going to the gym, you should be able to keep doing it, although sometimes not as often. If you’re a couch potato… my condolences. Also: Food. If you rely on getting it from your workplaces, you’re going to be eating a lot of bad, and often expensive, food. I didn’t think it was possible to find food worse than SF General’s cafeteria, until I went to the VA. Oooo-weee! Some clerkships will give you little cards to get free or discounted meals at the cafeterias. Usually your dinner on-call will be free. This may make it worthwhile to obtain food from the hospital. Also, many departments, esp. medicine, usually provide free pizza, burritos, or the like for noontime lectures—food paid for by drug companies. It’s not the healthiest stuff, and some of you may have reservations about eating on a drug company’s tab. I suggest bringing lunches whenever possible—they’ll be healthier and probably more appetizing, but packing them will take time.