An update on my journey

So I don't really know what I want to write in this post because my mind is scattered so it may be a bit of a ramble on. I'll try and organise my thoughts...I'll dump my thoughts on here and hopefully it sounds cohesive. You don't have to read this post. It's mainly for me to organise myself and figure out where I am heading.

Motivation is one of those strange things that is there for you until it's not. Motivation to me is the inner drive that arises when you have a clear goal in your mind worth struggling for.  It's a fickle thing because every day there are distractions that may cause us to stray from the path that we have set for ourselves. There is no inherent malevolence in these distractions, they are what they are. Sometimes these distractions are negative because they cause us to stumble and fall. Sometimes they cause us to stumble and we respond by increasing our resolve to achieving our goal. Sometimes they can be positive and cause us to realise that the goal we have set for ourselves may not be the best direction for us anymore.

Where I am right now:

Since July the 22nd (which was when the Primary exam orientation course ended). I have been pretty much studying everyday: during and after work, weekends and all. Honestly it felt pretty good to be studying again (weird I know). But with study came routine and familiarity. Remember, if you are a high school entry student to your dental school program you have been at school for a grand total of about 18 years when you graduate. The moments after my last formal, written exam (4th year oral medicine) I had no godly idea what I was supposed to do. Everyone went off celebrating and I got the strong urge to go home and study for the "next" exam even though there was none. I eventually came around and relaxed my 18 year long "school mode" sphincter but you can imagine that there is some comfortable place deep in our minds that study brings out.

Yesterday, for some reason that I can't remember, I a thought popped into my head: "why am I doing this?" My life up until now has been a series of big decisions with lots of little decisions peppered in between. I have realised my personality up until now was very heavy in agonising over the little decisions like whether or not I would buy something in a store or whether or not I would go out with friends one night but conversely making big decisions quickly, almost unconsciously. My thought processes for the little things seems to bring out the analytical side in me and i'll pore over the small details ad nauseum.

However, for the big decisions, where one could say where things really matter, I seem to make choices on a whim, based on a gut feeling: Moving out of home, moving interstate for study, travelling rural for work, studying for the Primary exams. And in a way the primary exams are a big-ish thing because I have spent a fair bit of time on them albeit time that I would have spend staring at the wall or ignoring social outings (I think my personality is showing through here).

I'm not really complaining about my decision making process though; I can't complain. It's landed me with a stable, well paying job in an interesting profession that demands the best from me. I couldn't tell you 5 years ago that I would be here (but then I didn't really think about it back then). I suppose what I am trying to communicate here is that I make these decisions and focus on a goal because I trust in my heart that things will turn out well for me (based on past experience).

Yesterday signals the first time I am casting doubt on myself. I have no doubt that completing the primary exams would benefit my career and professionalism positively which is important to me. I have no doubt that I would complete the study in time and would pass or even do well in the exams. I am that confidence in my abilities. I don't think that's arrogant, I think it's logical based on my experience and my gut feeling on how the study process has been going. What I doubted yesterday was that this was that continuing this challenge was the best thing for me right now.

I remember what happened yesterday now. I have been churning thorough the subjects one by one (jumping between them or looking ahead would overwhelm me). I might as well give an update on the actual study:

• Cell biology and biochemistry was fairly straight forward: It is basic university sciences (thought it felt as though I was learning them for the first time because it had been so long). Starting here gave me a false sense of confidence because it is a relatively small subject compared to the "main ones"
• Physiology felt less abstract and made more sense although there seemed to be more random topics that could be examined
• Pathology was a slog but actually quite interesting.  It was the first one with significantly more content and not much guidance on the depth in which to study
• Microbiology was massive. Much bigger than the lectures would imply but also really interesting too. I had Laurie Walsh through university and if I had understood then what I understand now I probably would have listened more intently during his lectures (that doesn't really make sense but whatever).

Anatomy is where I became unstuck. Remember how I said I avoid looking ahead, well I scrolled through the anatomy content and a few things got me:

• It was a massive subject, this and microbiology are the biggest two in my opinion
• It was very in depth, anatomy is one of those subjects at uni that I really enjoyed and was very good at (male dominated subject??) but when I considered how much effort had to go into this subject among all the other subjects it kind of got to me. By now, the enjoyment had been drained from study and the motivation to finish the job was the main driver
• It relied heavily on textbook learning to succeed, none of which I had (a silly point to make because I could just get the textbooks but it was just another point on top of other more valid ones)
• I was reading things I didn't really understand. Marc Tennant's lectures were fantastic during the course. A very soothing speaker who really knows his subject and speaks with passion. However he teaches anatomy in a way that we didn't learn at university. Honestly I was a superior way. It approached anatomy through the focus of embryology which to be honest is the only way to learn it. I don't know what our university lecturers were doing but rote learning anatomy is not ideal. However, the unfamiliar system I had to learn scared me put me off a tad.

By themselves, none of these points were a valid reason to give up after coming so far but put a few of them together with a 2 month long study period and the upcoming deadline to register for exams and I will forgive myself for having a couple of doubts. But that's all it was at the start, just a doubt or two. But these doubts led to one question: "Why am I doing this?" and of course I had an answer "Because you made the decision to". But that wasn't good enough for me anymore...

So I thought about it for the first time and tried to put logic to my gut decision. My gut decisions are never illogical, but just as it is true in your intestines, guts can change very quickly.

• The first obvious reason to do primaries is for entry into a specialist program. I'll say it now that I'm interested at the moment in oral medicine but this is another gut decision (haha). I couldn't tell you why I am but I am. I could probably make a list like this for that decision but I'm not going to. Because it's only at a gut stage right now I want to find out a bit more about the field before I commit to a program so i'm lining up some oral medicine experience next year that hopefully will pan out. I might love it or I might hate it but that's for the future to decide. One might argue that pursuing specialist qualifications implies that one is sick of general dental practice. Not strictly true because e.g an endodonist may just really like endo more than other aspects which he doesn't necessarily dislike. I am not unhappy with general practice but I do feel like something is missing in my professional life. Maybe it has something to do with my current job or maybe not.
• Another reason to do the primaries is to satisfy a thirst for knowledge and become better at being a general dentist. This is certainly true for me and to be honest it has affected my clinical practice to some degree. I spoke to some very skeptical people during the orientation who were only doing the exams as an obligation for further study. To them I say, keep an open mind; you'll get out of it what you want to. Don't get me wrong, the actual amount of clinical relevance is very little in the primary exams, but understanding more about pathology has improved my medical history taking (which was frankly inadequate) and knowledge of the aetiology of dental disease has improved my diagnosis and thought processes when treatment planning.
• Routine and a purpose: Please don't underestimate the power of routine and a purpose. When we leave the nest of our parents and education and wade out into the wider world it is up to us to make our own goals and find purpose in what we do. Working 9-5, 5 days a week for most of the year can be a routine in itself but it can feel like an obligation for some. For me, the primaries gave me a new purpose to fill in the time when I wasn't kicking ass at work. The routine gave me a reason to go to bed at the same time every night and to cut down on other time wasting activities. Unfortunately, I was so focused on the one goal (as I do) that it was impacting other aspects of my life (this blog being one example).
• To prove I can do it: For me, the prospect of starting a life in specialist practice is a big thing. Not just the three extra years of study but the (apparent) respect and responsibility that comes with this title. It's not all glory and in the end there is a job to do. If I am going to earn this responsibility that I need to prove to myself that I have the capabilities to get through the program and handle the job afterwards. Not sure how this crisis is going to affect that...
• Another thing on the CV: I suppose if I was scraping at the bottom of the barrel for reasons to do the primaries, some employers (especially for academic positions) would look kindly on this form of further learning) though this was never my goal.

So anyway, I started thinking yesterday and one thought led to another and another and another and I unconsciously made the gut decision to stop studying for the primary exams for this year. I know I have put a lot of work in it during the past 2 months so I said that I would sleep on the decision and see how I felt today. Last night was the first night in probably 4-5 years that I struggled to sleep. I employed all the techniques that I had learnt over the past year to try and clear my mind but my old insomnia was back (at least for one night only). 
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So I had another day to think things over and talked to a couple of mates and my thoughts are this:

Continuing study

Arguments for:

• I've put a lot of time into study already and I might as well get the exam over and done with
• Personally, my past gut feeling was that if I didn't do the primaries this year, I would never get t done
• I'm almost finished, I'm halfway through the study time period and only 2/6 subjects to go
• If i finish the primaries I won't have to think about it again in the future.

Arguments against:

• I'm not 100% sure that I trust the benefit in completing the primaries. There is a cost involved (cost of registering and time cost involved in study and time off work for the examinations) and does the benefit outweigh the cost? I'm not 100% sure I want to specialise in my field of interest and I'm not 100% sure the primaries are necessary to gain entry into the program. Maybe it would be better to gather more information on my interests first
• I haven't been overly stressed the past 2 months but the indecision in the past 2 days has been stressful on me. I'm not a particularly good planner but forcing myself to make this decision has called into question a lot of variables. Having the last 2 days off study has been great. Although study has not been too bad, in contrast, having time to work on hobbies, cook and complete actual dental CPD has been a refreshing change. I feel happier and more relaxed in the past 2 days than I have been in than the past 2 months. I know I have been coping with the study well but I feel like I'm on top of a slippery slope and as crunch time approaches towards the exams may overwhelm me.
• There is no shame in postponing this, it's a non essential, non urgent part of my life that I can put aside to focus on things that matter more to me.

I've been reading a lot into mental health and been doing some self reflection this past year and I've learned a few things along the way that I've put into practice in my decision making process:

• You need to prioritise your mental health. No one is immune to depression. Some people are more susceptible yes, but even the more resistant people can spiral downwards if given the right push.
• As a profession and even as a race we need to stick together to support our fellow man (and woman). Forming relationships and engaging in social activity is important in that it reinforces our purpose for being on this Earth. Some people need it more than others and as a balance some people need alone time to be with their own thoughts and recover their "social energy"
• I don't like to be alone as much as I thought I did. I do however prefer interacting with those who are positive and enrich my life. The others can do as they please. We are responsible for our own mental health; It is not selfish to say this. This may involve seeking help from a friend or mental health professional but just altering the factors in your life that are keeping you from working at capacity. In this case, I feel as though over the next few months, these exams may be a hindrance more than a help to my happiness therefore I'm removing it from my life. It's not the end of the world. There's always next time.
• You have to try and drown out the critics. There are people out there who will want to have their opinion and their say in what you do in your life. Unfortunately sometimes they're your family and you don't want to cut them out of your life. Listen to them and consider what they're saying but ultimately, form your own opinions and make your own decisions about what you are going to do with your life. In the end it is you that has to live your life, not your family and friends.
• Focus on the here and now. The past brought you to where you are now but it doesn't have a hold on you now. Don't let the past hold you back and remove opportunities for you in the future. I think everyone is worth a second chance. The future is scary but we can't control what will happen just like we can't control the actions of others. Don't let fear of what will happen hold you back. Focus on the now because that is the part of our lives we can control. You can have a plan about where you are heading but you need to take it one step at a time. Why should you suffer earlier than you have to? If something bad is going to happen then let it happen when it happens.

So what does this ramble all mean? I'm not sure I can put my thought process down into words any better than I have done. For now, I'm going to take a step back and evaluate for myself the best way forward. I don't want to let pressures from career and others negatively affect my state of mind so I've opted for the path of least resistance. Some would call it the easy way out but is that a bad thing? Why shouldn't we do what's easy? Maybe this will turn out to be a mistake in the future but that's fine too. Life is trial and error in the end and it's the errors that teach us the lessons worth hanging on to.