Anxiety

Hello blog. I have been feeling overwhelmed these past few days and need to get my feelings out there. I hope this will help me release some of the stress I am currently holding inside and therefore allow me to "lock-in" and focus on my studies.

I remember feeling incredibly anxious on the days leading up to my last exam. My next exam is not for another 2 weeks; however, I am currently feeling the pressure. This pressure to succeed is exacerbated by the fact that I have failed multiple exams in medical school. Although I did eventually become diagnosed with ADHD, I still can't help feeling like a failure and feeling sorry for myself. I am extremely hard on myself. I tear myself down, mentally. I perform negative self-talk all the time. In my mind, I see my thoughts as factual, logical, and grounded in truth. I am a stubborn individual; my opinions are difficult to change. It is difficult for me to believe when others have nice things to say about me. When I do believe these nice things, my mind immediately starts to enumerate why they might be lying, mistaken, misinformed, wrong.

Part of working on myself requires me to ackowledge that this thought process is erroneous. More practically speaking, this process is also unhelpful. I end up becoming paralyzed, restless, and unable to focus. To be practical, I must adopt actionable steps to help me. That's right! I aim to employ a top-down approach; the bottom-up approach hasn't been working, and I am finally ready to try something new. So here goes.

1. Structure your time.
2. Coordinate ahead of time.
3. Set your phone away. Those texts are not urgent.
4. Delete TikTok, spend less time on social media.
5. Adopt hobbies; things you can enjoy aside from entertainment.
6. Make a plan to exercise. Until you do, all you have are desires, not goals.
7. Take. A. Breath. You can do this! :D

Friendship

Hello blog! I tried to avoid looking at my last posts, but I did just see that the last time I posted was pretty much exactly 1 year ago. A lot has happened during this time...let me start off by saying what I came to say.

This is a personal journal of sorts for myself. No one has the link to my blog: it's all for me. I don't think I even want to show this to anyone eventually; instead, I want this to be a safe space for me. I think that's how I have utilized this space before, and that's what I will continue to do. This is my domain, and I will use it to find my voice. I will use it as a tool for reflection. If some random person finds my blog, I hope my thoughts are somehow helpful to them if they can. So here it goes.

I moved back home 1 year ago because I became depressed. I was overeating, spending the day in bed, rotting my brain and life away, and quite unmotivated to continue working toward my degree. I felt powerless, weak, alone, and most importantly: I lost vision of who I am. I believe I experienced "ego-death" in some way. I...am simply not the bright-eyed, over-achieving nerd that carried me through my entire K-12 and college experience.

In the present: I am a 25-year-old male. I am the first in my family to enter medicine. Heck, I am the first in my family to graduate college. I was diagnosed with ADHD. I continue to struggle with self-esteem and anxiety. What drives me in life is to learn science and to earn money to support my family. And I mean, a lot of money. I want to provide for my little brother. I want to provide for my boyfriend, who is the light of my life and with whom I look forward to building a life together.

I thank my father a million times for this; it is his work-ethic that I have come to appreciate through the years that I draw inspiration from; despite his flaws, he is a hark worker and no one can take that from him. I know Father's Day was yesterday, but maybe I can tell him that today.

I am currently at a tea shop with a friend. Even though I don't always agree with the way he does things, I really appreciate the person I see in front of me. He's been through a lot, and his courage to continue forward inspires me. I wish I were a better friend in terms of consistency and hanging out more. I want to be a little like him. He's learning too and working hard for something, and that's something I both value and admire. I am thankful he always asks to hang out with me, even when I don't.

Anyhow, I should really get to studying. I have important things to do. I suppose I can write about that another day. I'm looking forward to it.

Why am I here and what am I doing

Oh boy, isn't that the age-old question. It's currently 1:31 P.M. at Starbucks. I have my Family Medicine shelf exam tomorrow. I have finished all my UWorld Family Medicine and Ambulatory questions. I only need to review them, as well as take an NBME assessment. For the past 12 hours that I have been awake, I have been avoiding studying. For some reason, I suddenly starting feeling anxious. I was doing so well, too! I had therapy yesterday and felt good. However, at the present moment I am feeling alone, scared, stressed, and worried about studying. I think writing here will help me feel better...I think/hope. Heh. At least there is hope. Okay. *INHALE* pause...and *EXHALE* I feel a tinge bit better.

Okay. I can do this. I KNOW I can do this. Am I actually hyping myself up? Yes. I am not as anxious or depressed as I was even 2 months ago, let alone 9 months ago. I am powerful. I know that I am. I know I can get this done. So what am I waiting for? Just do it. Okay. Yes. Here we go.

Self-Efficacy

Self-efficacy refers to an individual's belief in his or her capacity to execute behaviors necessary to produce specific performance attainments (Bandura, 1977, 1986, 1997). For the past year, not only have I experienced loneliness, anhedonia, and low self-esteem, but I have also lost the majority of my self-efficacy. I no longer believe I am able to set and then reach goals I set for myself to achieve what I desire.

Part of this is surely explained by my lack of confidence in my own worth and ability as a person: my self-esteem. Put simply, I don't really trust myself. I don't think I'm capable, at least not deep down. Because I've grown tired of failing to reach my goals, I think I eventually resisted the urge to even try. In turn, I developed bad habits, such as too much screen time to help me relax, or lack of exercise to save my energy for studying. My perfectionism also contributed in the sense that I started to not even start studying if I didn't think I could conceivably achieve everything I ought to do, like all my practice questions and case studies and using reference texts.

However, even in the good times, when I find I am without significant impairment from symptoms of depression and am general mentally well, these habits persist and prevent me from even attempting to do what needs to get done. This includes not just studying, but cooking meals for myself, any exercise at all, completing my laundry, and even menial tasks like brushing my teeth.

Today I feel good. I am not currently stressed by the impending threat of exams. In fact, I believe I can do what needs to get done. I can incorporate movement in the morning and hopefully throughout the day. I can get through my question banks. I can reduce my screen (specifically entertainment) time. Hooray!

Finding Myself

Good news! For some reason, I have been especially motivated for the past 24 hours (it feels way longer than that). My mood is stable, I'm feeling neutral-positive, and best of all I am advancing in my studies (and no, I'm not writing that down to make myself feel better after an hour of studying).

I want to take a second to write on my experience with learning, burnout, career interests/choices, and living. Okay whoa, actually, maybe I'll just touch on the learning. I came across a practice question on UWorld I got wrong. My knowledge gaps were simply too great. However, reading the explanation made me...happy? I loved how the explanation gave the pathophysiology of the diagnosis, as well as for the incorrect options, as the rationale for the right answer. Today, I have learned that pyogenic granulomas commonly occur in young adults, and in particular, pregnant women, likely due to the normal pregnancy-mediated increase in vascular endothelial growth factor (VEGF) that may promote pyogenic granuloma growth. They characteristically bleed with minor trauma and can be surgically excised, but laser therapy and topical silver nitrate are other treatment options too. In pregnant women, pyogenic granulomas usually regress postpartum and may not require treatment.

Also known as lobular capillary hemangiomas, these <1 cm lesions are vascular tumors composed of abnormal capillaries and granulation tissue! They typically present as friable, dome-shaped nodules on the hands, trunk, or oral mucosa/gingiva.

Anyhow, my little brother's choir concert is tomorrow (his last ever *sheds tear* since he's graduating high school in less than a month). I am so proud of him. I see how much work he puts into his studies. I see the dedication, the drive, and grit to reach his maximum potential. I'm smiling just thinking about it.

Burnout

Hello journal!

It's currently 9:32 P.M. on a Wednesday night. My surgery shelf exam is in 9 days, and I have yet to advance in my UWorld question bank. I had quite the rough day. After returning from volunteering, I did...nothing. I spent the day in bed, mindless scrolling in my phone. It was the classic feeling of not being able to quite start a task. To make matters worse, I know that even once I start a task, there is no guarantee that the ball will keep rolling. This is because I get distracted extremely easily; the lack of focus is real.

After a keen move in hindsight, I texted a very close friend living in another state about my troubles today. We had a great conversation and he suggested that I might be experiencing symptoms of burnout. I realized he was right: I am burnt out. The feeling is definitely familiar, but now I can say why. The not being able to get out of bed, the wasting the day on the phone, they self-torture of knowing I need to work but for some reason cannot bring myself to do it: all part of the burnout.

I know looking at studying through a different lens would help address the burnout. Seeing studying as an opportunity to expand my medical knowledge instead of as work might help me actually enjoy being a medical student as opposed to dreading and resenting it when the going gets tough. Of course, easier said than done.

Yesterday I helped my boyfriend make mole and rice. When things weren't going the way he had planned, I erroneously proposed solutions when I should have spent time validating his experience of frustration. Apparently I had made things worse by offering help and giving advice. It's funny to me as I say this because I typically think I am good at recognizing, listening, and even feeling the emotions of others. However, I definitely have tried to fix problems before listening first; thus I can see how and why my actions were in fact unhelpful. I am sad that an immediate thought I had was considering what would happen if we were to break up, why he isn't someone I want to choose as a life partner, and so on. I know one of my toxic traits is distancing myself from people and exhibiting hyperindependence. The thing is, I wasn't feeling close to him last night. In fact, I was pretty uncomfortable. However, I don't know if my discomfort stemmed from him as a partner or if it was because of my own unease and panic when people around me are stressed and there's nothing I can do to help, fix, remedy, or give a solution to address the problem. The fact that he didn't even really want me to help me go through his feelings made me feel pretty useless as a partner. I know I have the problem of wanting to "fix" things for people, but I also don't think it's unreasonable for partners to be there emotionally for each other, which I can honestly say has been missing from our relationship. Does this whole situation highlight the incompatibility between us? I don't know. I want to lean yes and consider other reasons for breaking up. However, I've done this before and later regretted. Just a couple weeks ago, my boyfriend and I were the closest we had ever been, romantically speaking at least. It's odd to me how fast feelings might change. I dislike that about myself. I'm also realizing my low self-worth pops out a lot as a recurrent or ever-present theme in my writing. Sigh.

I actually feel a tad worse after this post. This makes me sad as I was thinking blogging would have the opposite effect. Maybe this is all good reflection for my therapy appointment I have in two days.

Self-Love

Hi blog. Can I still keep calling it that? I know this is really my journal. Only a few people know this forum exists (although I've forgotten who I've told, exactly).

I recently came to realization that I am spending my day-to-day experience with some form of depression. It is a mild form, which I say not to minimize my experience but rather to highlight that my depression is not fulminant or debilitating; rather, it's simply been making each day a little harder, and progressively so, at least recently. What this looks like is self-neglect: I don't brush my teeth at night, I don't study, and I isolate myself from my friends or peers. My feelings of anxiety have been worse over the past week, although it feels like it has been longer. What this looks like is I'll avoid certain social situations in attempt to save myself from the judgement of others (in reality I believe that this is self-judgement). I've been "on edge" and sometimes unable to relax outside of mindlessly scrolling social media, which isn't exactly relaxing either. I just choose to sleep.

Self-judgement and isolation exacerbate the anxiety and depression. I guess you could say I've become comorbid (I really just wanted to use that word in a sentence). Again, I don't write here for an audience, since this is a website that I have told no souls about. Maybe when I'm old I will consider sharing this with others so that they can see the kooky-crazy that's riddling my 24-year-old mind.

I feel better after crying earlier. I spent a few hours "wasting time" in bed, alternating between my phone and trying to sleep. I had a conversation with my boyfriend (4.5 months as of today) this past Sunday that ended with both of us feeling very bad, but it feels like ages ago. We've talked since then and decided to talk again at another time. I think it's important that we undergo difficult conversations and work through them in the end. My anxious feelings did get worse this week, which are probably in a way related to our relationship. Anyhow, today I confronted my feelings of high self-judgement and low self-worth. I briefly considered the internalized homophobia that I do too good of a job at ignoring and compartmentalizing.

Something I can do right now: stop criticizing myself every time I don't meet my own standards of how I am living or how I think I am supposed to be. Another thing I can do: keep myself accountable so that I don't break commitments I make to myself. I've been in a perpetual cycle of saying I'll make changes only to fall through again and again and then proceeding to repeatedley judge myself and be too harsh to my mind. Ideally, if I stop myself from being critical and harsh, I will be one step closer to experiencing self-love. This self-love will hopefully empower me to keep commitments I make to myself for self-improvement. I think the way I've set up this framework avoids my discomfort with being selfish, which is an obstacle to address another day (that, and the intellectualization of my emotions; I don't think I forget "feel" my feelings, though, so that isn't actually as maladaptive of a defense mechanism in my view).

Here's to loving yourself.