My PLE Journey 2 of 3: A mental health break(down)

The style of this blog post is different from the first and third parts of the #PLE2021 Series. Read only when you have the time and emotional energy. It’s also a bit personal.

In this blog post:

  • A journal entry entitled “on intrusive thoughts”, written a week before the exam
  • Ways to deal with anxiety (from personal experience)
  • Manifesting gratitude

On intrusive thoughts

I’ve always had a reputation for being stoic and intimidating. In the matrix of life, what I lacked in social awareness, I more than made up for in self-management. My mentor in medical school had told me (I think more than once) in a one-on-one session that she never really worries about me or my ability to cope. She knew that if I had a concern, I probably also already had an action plan. Academics, family, extracurriculars, social life. I took pride in my self-sufficiency.

But preparing for the PLE in a pandemic puts it to perspective. (I really tried for alliteration!). I had my first proper nervous breakdown only ten or so days before the exam. My heart was in my throat, I was hyperventilating, I was crying, I was making sounds only bats and lonely whales could hear. I was scared for and of my future. It was the culmination of a primal instinct to avoid anything I associated with fear and danger. At the same time, I was taking that same fear and anxieties out on other people.

Since the start of review season, I felt almost disconnected from my peers who would write and talk about burnout, fatigue and stress. I thought I could only feel a healthy level of anxiety; enough to keep me going, but not enough to bring me down. It turns out that the boogeyman I had been ignoring had grown over months without me watching.

Big enough that I didn’t think I’d ever feel lower than that night. But as I am continuously reminded by life and the universe, I can and will be wrong.

The next day, when I tried to apologize to someone I hurt because of my then-inexplicable fears, to explain but not excuse that I was struggling with depression and anxiety, this person I hoped would be patient with me said that I was being OA (for those unfamiliar: overacting) and that I should stop putting blame elsewhere, specifically stop blaming them. This same person also said I shouldn’t claim that I would pass the PLE. It was too overconfident. My shortness of behavior, my non-verbal gestures displaying anxiety and loneliness, my outward displays of selfishness (I am normally a very malambing or sweet person to those I am close to) —they said these actions reflected on them, and only showed my lack of respect for their authority.

Nine days left to the exam, and I was devastated. I thought: maybe I am overconfident. Maybe I can’t pass. Maybe I am overacting and overreacting. Maybe I really don’t know how to manage myself and my emotions. Maybe I was intentionally showing disrespect. Maybe I deserved only disrespect. Maybe I was a burden. Maybe, maybe, maybe.

The thoughts were so intrusive I don’t know how I functioned.

Honestly I thought that would be the end of me. I kept wondering why, in a discussion of feelings, mine didn’t seem to matter. Every few minutes I’d think to myself, why are these unintentional hurts only bad when I am at fault, but never remarkable when I’m the one hurting? At some point I even caught myself dealing and banishing these intrusive thoughts more than 50 times in one day. (Yes, I counted. Turns out, flagging and counting intrusive thoughts as they come can be an almost viable coping mechanism.)

But you know what happened next? A miracle of a motto. My mental space was struck by lightning. I remembered one of the biggest and hardest lessons I learned in med school:

Once you’ve hit rock bottom, there’s nowhere to go but up.

And out.

I reached up and out, probably disturbing and inconveniencing people in the process. I remembered how the Topnotch review center teachers would always say “kaya niyo na ‘yan” or “papasa na kayo!” when the class would perform well in a quiz session. They believed in us, ranked red or green or yellow or otherwise. My sister listened to me as I cried for what felt like the tenth time in 24 hours. She even cried her own hurts, and suffered a headache for her troubles. My ate validated my experiences.

Friends shared their own anxieties and offered ways to support my road to growth. I scrolled through encouraging tweets. There is an entire community of people with similar fears and anxieties to be found in #PLE2021. I wasn’t alone. My aunt replied back with a message of support and a cute GIF. My brother said, confidently, from miles away, that he was sure I can pass my exams.

That simple and unshakeable faith from the people you love.

It was the first time I was fully on the other side of this conversation –that is, receiving generous support, instead of awkwardly giving it. It was a relief to hear that it was okay to be anxious, okay to feel invalidated, and okay to feel hurt by lack of closure or mutual understanding. And from this side I can definitely say, apparently it really doesn’t matter how eloquent you are when you give support. As long as you’re there. As long as you listen, without making it about you or adding to the shame. Offering a shoulder to cry on and an ear to listen is enough.

The weight that was bringing me down gradually faded when people I trusted acknowledged my feelings of fear, hurt, and anxiety. I lifted them up to good people and they took it away. No excuses, no caveats, no tie-backs. Patience, where patience was sought. The reassurances were all so clear and straightforward. A warm switch in my heart and my brain, because the neurons in my mind were mirrored by those in my family and friends. Empathy and love in practice.

Suddenly I had the drive to study! Even to sleep and wake up early to adjust my body clock. I absolutely could not let any of these wonderful people down. And most importantly, I could not let myself down. I could only master myself.

I AM STILL AFRAID. I still don’t know how to face the anger and hurt of people I respect and trust (without a dose of suppression or sublimation). Some feelings are too big for the mechanisms I’ve built.

But I am more than that moment. I am more than my fears and insecurities. I am more than superstition, more than prayer without action, more than empty confidence. I am more than that same tired hand reaching out to nothing. I was and am 25 years of competitive education gearing up to take the biggest exam of my life. I was and am confident of my effort. I was and am also looking forward to finally paying and sitting down for a therapy session.

I know I’ve had good grades before, I repeat like a mantra against this building imposter syndrome. I have an archive of messages and handwritten notes of love and support. Here are facts, here are evidences.

Thank you for those who believed the best in me, for those that didn’t, and for those who’ll choose to believe and listen in the future.

Note to self, note to others: reach out. And reach back.

I can only wish I was mad. Instead I fear I’ll break before I bend; acknowledging hurt is akin to scooping out my own chest. Feeling simultaneously resigned and determined is exhausting –but maybe healing, in its own way.

It’s disruptive realizing a lifetime of thinking “I don’t feel a lot of emotions” is actually a lifetime of believing “I don’t deserve to feel strong emotions”. It’s a revelation —that the years have taught me to value my preferences less, to think I actually always like being alone in my own inner world, to run away with justifications and self-deprecating humor, to think of my emotional desires as non-existent.

Here is the truth I am now learning to believe: my feelings are as valid as others’. I have no obligation to compromise myself to fit the feelings and beliefs of others. I don’t have to “go along with it”. Myself as an emotional being, as a rational human, as a person —this self is deserving of respect and acknowledgement, too.

Love yourself, love myself.

On intrusive thoughts
Log: 2021/10/21

Okay! Now that that depressing journal entry is out of the way, let’s go to the positive side of things:

Ways to deal with anxiety

I am constantly learning how to deal with my own personal doubts and anxieties. I oscillate wildly between being a perfectionist and having a devil-may-care attitude. Is it the scorpio in me? Is that how it works?

This article from the Philippine Star shed some light and lightness to my mood. Dr. Honey Carandang, a psychologist, begins with the ever-true “it’s okay to not be okay.”

Read here: Pandemic anxiety could be permanent: Psychologist gives tips for prevention.

Some of the tips were similar to the ones given to us by Topnotch and ASMPH mentors.

A quick rundown of exercises to help control pandemic anxiety (and PLE anxiety):

  • Face your emotion
  • Self-care
  • Be creative
  • Listen and support each other
  • Reach out as soon as you’re having suicidal thoughts

During my lowest moments, I found myself doing my skincare routine less often. I also stopped exercising for awhile. Sometimes, resting from workouts is fine and healthy. But I could really feel the emotional heaviness stopping me from unrolling the yoga mat.

But even if I didn’t have the time or energy to do yoga, the breathing techniques and tips on good posture actually helped me out. Aside from deep breathing (try the 4-7-8 method, or the square method, or just a simple 5 seconds in and 5 seconds out), body awareness exercises also helped me stay physically calm.

I can actually hear the voice of the yoga instructor inside my head whenever I face difficult situations:

Inhale here. Face relaxed, shoulders soft, spine long, and hinge at the hips. Then exhale.

Some Down Dog Yoga Instructor, probably

A couple of days into my slump, I started letting out my feelings by making random music video-style edits with words capturing my feelings and experiences. There is catharsis in creative pursuits.


I also found that when I do “nice” things for others, like sending a short supportive message or showing concern, I feel better about myself and my own situation. Of course, I couldn’t do too much —I only had so much of “me” left to give.

As we learn in psychiatry as medical students, the four “healthy” or mature defense mechanisms are sublimation (transforming socially unacceptable impulses into socially acceptable actions), altruism (doing things out of a desire to help others or concern for the well-being of others), suppression (a conscious effort to put disturbing thoughts and experiences out of mind) and humor.

In this way, I find listing things I’m thankful for to be a positive exercise.

Manifesting gratitude

To end this post on a more positive note, this is the part of the series where I would like to thank everyone who sent in prayers and gifts over the review season. I’ve already sent in personalized notecards (you know who you are), but a shoutout or two never hurt anyone.

Of course, there’s thanks to my family. Thank you to my mom for literally putting me through med school (and supporting me financially even now that I’m technically an unemployed bum), to my sister for driving me everywhere and buying expensive coffee during the weekends, Ate Risa for the privilege of not having to think of washing dishes or doing laundry, my brother and sister-in-law for their words of encouragement.

Thank you to my aunts who offered special dedication to masses and recruited more than one priest to the cause. Thank you to my batchmates who’d send memes and tears from wherever and whenever. Thank you to my med school juniors, college and high school friends, and study-buddies for sending care packages, donuts, coffee, and more.

Thank you to Ben&Ben feat. Zild and juan karlos for their song Lunod (and really, Ben&Ben for their excellent new album), to Dr. Lou Querubin and VP Leni for your encouraging words, to Umar Ibn Al-Khattaab for his timeless wisdom, to Jesha for reminding me of Max Ehrmann’s Desiderata.

I have a lot of reasons to be grateful. I can only hope to pay it forward.

Some of the selfless gifts I received from friends and Pugad Agila, early on during boards review season 1.

Until next time! ❤️

You can find my other #PLE2021 Series posts here.

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