Trying to push through a trigger to get some help

[Liliuokalani]

I have crippling, crippling stage fright. And the funny thing is, I have been a theater nerd for most of my life. I have been doing theater, dance classes, singing classes, all of my life. It's always been a passion and a hobby. Now, I'm a medical student, and those theater days are weirdly coming back to haunt me. We take a big important life-altering exam in which we do an EIGHT HOUR long practical, we see 12 standardized patients (actors), do a physical exam and such, and then write a note. You get 15 minutes to speak to a patient, and 10 minutes to write a note. Yikes. And they are WATCHING YOU. The actor is watching everything you do and say and checking off boxes that you asked specific questions and did certain maneuvers. That you expressed empathy, validated concerns, used teamwork skills to include the patient. It's called a patient-centered interview. Most of us do have souls, but some incredibly smart people are like walking machines and need a little extra help in the empathy department and I think this is mostly geared to week people with no social skills out.

However, I'm really scared it's going to weed me out. All through my years in theater, I have never really improved in the stage fright department. I have never really desensitized. And I'm trying to search through my feelings, and my past experiences, and I'm trying to figure out why. I think it's that inner critic and that need to be perfect. To have perfect people skills and if I have one awkward moment of silence where I may have forgotten what to say or do, sometimes that's all it takes to tip me over the edge.

So this fear, it's keeping me from getting more practice. That, and, a hospital I used to rotate at, very close to my home, has teachers regularly running drills for this exam. So why can't I just go there, sign up, and practice? Other than my crippling need to be perfect in front of an audience, be liked by everyone and seemlessly flow from one question to the next, I also had a HORRIBLE, traumatizing experience with one of the attendings. She was my educational coordinator of one of my rotations and she emotionally harassed me on a regular basis. She just picked me out one day and bullied me almost every day, from that point on, and almost got be kicked out of the hospital because she twisted the truth to her higher ups and made it seem like I was abusing her. Well, luckily this has since been cleared up, I passed the rotation, no major harm was done to me career-wise, and she is no longer allowed to teach students. However, the scars in me remain. And just driving to that hospital just makes my skin crawl. I go in and just think, this is the place where no one cares about me. Once an intern ran up too many stairs and passed out, no one even acknowledged he passed out, a student had to tell the surgery team he was doing morning rotations with. I don't think the residents are treated well and then it trickles down to the students. We are also often judged harshly just based upon what mood the attending happens to be in that day, and no amount of sucking up changes anything.

I just feel helpless, like I am at the mercy of the unpredictability and crazy emotions of everyone around me. I know in my logical mind that this hospital no longer has control over my grade. I'm done there, relatively unscathed, alive to tell the tale. But I don't want to go back. I sit for hours just shaming myself. Why can't you just go in there! Your grade will suffer! You can't find people to practice with because they're all busy! This is your only chance! And then I shame myself for shaming myself. And then there's a vicious cycle.

I don't know how to help myself. Luckily once this test is done, if I pass it, I won't really have to do that ever again except I think to be board certified in whatever specialty I go into, but I don't know much about it. I just have to make it to the end of Monday. But every day it's like the pressure cooker just builds more and more. I couldn't even get out of bed for a very long time this morning. I'm so exhausted, falling apart, and I'm trying really hard to figure out how to move past this.

I'm trying it all- writing about my feelings, positivity, EMDR, TAT, tapping, meditation, yoga, sleeping well, eating well, distraction, exercise, talking with my therapist. Everything. And yet these feelings that I can't get in control, they are very scary.

[Boatsetsailrose]

My 12 step programme has taught me to work with acceptance - acceptance of my experience -
Pushing myself and trying so hard to over come my emotional world often has the opposite effect -

And fear yes. - I may fail something but all I can do is my best with what I have - work is important but not as much as my health and Ive worked to put me first - and my limitations

There is a drive in me to push it harder - go quicker and --- exhaust myself so all I can do is nothing -

Middle ground

When fear turns to terror I know I have not been in that middle ground - that inc all sorts of things

The worst that can happen is I fail or don't match my high expectations and if that happens we'll then I'm human just like everyone else

Best wishes and breathe

[Kizzie]

Hi Lili - sending you a giant  and hoping you're getting through this.  I just saw your post and I am hoping that these last few days weren't * for you.   I can't speak for the attending you have to deal with, but I regularly have students from the training side of simulations like the one you are going to go through or have gone through and to a person their main goal is not to take a learner down, but to build them up. 

Some of the physician's you are working with undoubtedly think they are making you stronger, tougher so that you can handle stress. The Cdn military used to do this regularly in years gone by but this is no longer the case because the org figured out it was better to build people up then tear them down.  Unfortunately it sounds like some in your field have not figured that out.  And of course, there are always those know nothing about teaching and just like to beat up on their students. 

I just had a student in my last course whose job it is to design and run those kinds of simulations and like others before him he was all about helping medical students to become better physicians, by learning from mistakes and building on strengths.  So I guess what I'm saying is that while there are still those like your attending (who imo should not be allowed near any student ever), rest assured there are many professionals behind the scenes who are concerned with your well-being if my students are anything to go by (Adult Education field).

It might help to hold onto that thought in these tough periods, and try to reach through all the layers of crap and trauma and the shame we all seem to have in common have over never being able to be completely perfect (and realistically who the heck can or wants to be perfect?), and  begin to think differently about (some) other people, to trust that not everyone is out to take us down as our abusers were.   And more importantly, to think differently about ourselves, that we do not need to be perfect in all that we do and it's ridiculous to think we ever could have been or can be, to begin to trust more in ourselves and honour our humaness (not sure it's a word but it fits).   We just tried to be to stave off the inevitable criticism and shaming that came our way when we weren't.  Well phooey to that!! Shush that ICr ("OK, I know you're trying to help but, you need to be quiet now, I've got this"), try trusting in your self and keep going with the self-care 

PS -I know this sounds like CBT but I don't mean it to be just about thinking differently, but acknowledging the layers of crappy feelings that are welling up and trying to counterbalance them with more positive thoughts and feelings if that makes sense.  At least that's what I was going for - hope this didn't end up sounding like the pdoc!