Monday, April 19, 2010

this is what is known as a multi-pronged approach to preparation

One other consistent piece of advice that I received about taking my oral boards (yes, I'm talking about the fucking boards again, but just bear with me, they're on Wednesday, and then hopefully never again) is that I should be sure to take some beta blockers before showing up. This under no less authority than my partner at work, the oral boards examiner himself. As he explained it (and not like I don't know this to be true, but he's actually seen it happen year after year) is that when you show up to take the boards, you are very NERVOUS and you get a HUGE CATECHOLAMINE SURGE and meanwhile you're WAITING AND WAITING for your exam to begin and your SYMPATHETIC NERVOUS SYSTEM is all revving OUT OF CONTROL, so by the time you actually get into your first test room you're all WRUNG OUT and EXHAUSTED and SHAKING, which just makes you feel like hell before they even ask you your first question. Also: flop sweat. So, I agreed that if he thought it was best, then beta blockade I would.

(Now before the non-medicals accuse me of taking the PERFORMANCE ENHANCING DRUGS, let me assure you that this is not the same as blood doping or taking, I don't know, Ritalin or whatever. Beta blockers are a non-narcotic medication usually prescribed for hypertension and/or ischemic heart disease that work on bringing down your blood pressure and heart rate, thereby reducing the stress on your heart. They have no psychotropic effects, and lots of people--actors and public speakers in particular--will take them for stage fright and whatnot to block the physical effects of anxiety. So don't worry, I'm not juicing like Drago in "Rocky IV.")

Anyway, beta blockade seemed like a good enough idea, and conveniently enough, I actually have some metoprolol at home, which Joe has been taking for a few months after his run-in with myocarditis. (He mainly takes his to suppress ectopy--that is to say, he gets palpitations and the metoprolol smooths them out.) However, given that I don't usually take any medications to reduce my blood pressure, and it's not like my baseline blood pressure is super high to begin with, I wanted to do a trial run with the metoprolol. You know, so I wouldn't take it for the first time and keel over in front of my first two examiners in some ungainly display of orthostatic hypotension. You know, like a demo.

After taking half a tab of metoprolol this weekend (which had basically zero effect) I took a full tab today. And I felt...the same. I thought my heart rate was maybe a little bit slower, (it was maybe high 70s when I took the med, and when I checked it again it was low 70s) but how could I say for sure, I was sitting down, I'd had something to drink, I was chilling out in a Starbucks for chrissake--not exactly the greatest stress test in the world. Of course, you could argue that the fact that my heart rate was not higher after drinking coffee was diagnostic, but I had a chai, so who knows how much caffeine is in that? Anyway, I had dodged the worst case scenario (read: I WAS NOT DEAD) but as for the intended effect of the beta blocker, I still wasn't sure.

The one other thing that I wanted to do today was take a test drive to the hotel where the exam is being held. The oral exams are being administered there all week, and candidates are told a specific day and time to show up so that they're sort of staggered throughout the day, Monday through Friday. I know where the hotel is (thank you, Google Maps) and I know that it's only 9 minutes from my house, but given that it's a busy part of town during a busy time of day, and given that I am the novice driver you all know me to be, I thought it best to practice the drive.

Well, I drove to the hotel. But see, where this hotel is located is right next to the on ramp for the highway, and though I could see where the hotel was--if I stopped my car and got out, I could have actually walked right up to in in about 30 seconds--it was one of those things where I couldn't see any way to turn into the driveway, and once I passed the hotel it was all MUST TURN THIS WAY and LOOP BACK THAT WAY and DO NOT ENTER and THIS WAY TO THE INTERSTATE. I had been warned about this last week, but seriously, that area is a major clusterfuck. And so I was slingshotted in the traffic like a helpless projectile, trying to figure out how not to end up on the interstate and how to loop back to the main street, all while trying to avoid all these Atlanta drivers who were all honking and merging with their penis-substitute convertible sports cars and all giving each other the finger (honestly, I grew up in New York City, and I've never seen as many drivers give each other the finger as I have in my two years here). It was terrifying. But even though in my mind I thought, "This is terrifying," my body did not feel terrified. My body felt calm. In fact, when I finally got out of that traffic vortex and stopped at an intersection, I checked my pulse. Still in the 70s. So I guess beta blockade works.

I had to loop back around to the hotel a total of four times before I finally found the entrance driveway, by the way. And then I saw all these people walking around with suits and notecards looking like they were going to puke. So that made me nervous again. But only in my mind, not my body. My body was sipping boiling water and spitting out icicles. Yay for beta blockers!

Medicolegal addendum: Please know of course that beta blockers are not for everyone and that there are certain conditions that should preclude you from taking them, consult your primary care doctor before starting any prescription medications, etc. etc. ad infinitum


  1. Heh. I'm not the only one, I guess. My combo is Inderal, Provigil and DDAVP.

  2. Anonymous5:44 PM

    Just to split hairs, a beta blocker IS actually considered a performance enhancing drug and is illegal in multiple athletic competitions (gymnastics, biathalon, etc). It may not make you stronger, but it can make you better.

  3. ROTFL!!! "Penis-substitute convertible sports cars!!!"

    Oh, how I adore your blog!

  4. Re: Anonymous @ 5:44pm

    Really? I was wondering about that. Of course it combats performance anxiety but I thought that the decrease in cardiac output from the lower heart rate would make it disadvantageous for athletics in particular. Interesting! Thanks for the info...

  5. Anonymous6:19 PM

    Good luck for the oral boards - well done on the hotel drive by, btw, great idea - nothing ruins a meeting/interview/exam more than stress due to the trip there!
    FYI - we were always taught beta blockers were great for archers, shooters; anything that required complete calm to ensure precision...

  6. Haha, one of your funniest posts ever, Michelle. I think you get funnier when you're stressed. Good luck with the exam!

  7. Anonymous6:25 PM

    Now, boring motherly advice that you can never hear too often and will never admit you use...remember to take a handerchief and go to the bathroom as soon as you get there even if you don't feel like you have to go....and don't wear new or fancy underwear (it might ride up or itch...) and have a sip of water before you start, and breath before answering, and turn off your cell, and, end... and.. ha can't think of any more pearls of wisdom at the moment..!
    Good Luck (-:

  8. Hmmmm...I wonder if the Beta Blockers would work for the Bar.

  9. "Sipping boiling water and spitting out icicles." -- v. funny!

  10. OH_EM_RES6:45 PM

    Yes. LOL

  11. Anonymous8:18 PM

    yes, they are banned from the Olympics since some archers were using them to great advantage...

  12. Anonymous10:33 PM

    good luck michelle! you'll be great! you better tell us all about it!

  13. Anonymous11:05 PM

    Great idea taking some test doses ahead of time.

    I have heard too many stories of people going syncopal in the middle of their exams. One who passed out, hit the table on the way down, and had to get 15 stitches to close the head wound.

  14. a grande chai at starbucks has a caffeine content comparable to a shot.

    i have confirmed this with the baristas many times ...

    "does your chai have caffeine?"

    "oh yes! but we also have a caffeine-free version..."

    "NO! NO! i need the caffeine."


  15. what a great idea to test run! glad it worked out. i know stage musicians use them a lot for stage fright and it doesn't cause motor retardation like another group of drugs... (forget which ones). good luck on oral boards! you'll knock 'em out!

  16. Anonymous9:47 AM

    Just wanted to chime in and wish you luck and kick-assness on your boards.

  17. Anonymous10:39 AM

    Biatheletes are skiing around at breakneck pace and their heartrates get way up there. As they ski into the shooting range they are doing breathing exercises to slow their heartrates quickly. They actually fire their guns *between* heartbeats when their gun is steadiest.

  18. Anonymous4:49 PM

    Good luck! Post a pic of your outfit!

  19. Anonymous6:02 PM

    I took some for my oral boards as well, and I think it did help. Good luck- I know you will do a great job!

  20. Good luck on the boards. You will do great.

  21. Anonymous1:37 AM

    I read a fascinating article about beta blockade in professional musicians prior to solo performance, particularly violinists who need precise finger placement to not be out of tune. Ethically, whether taking a drug which makes you perform better by alleviating natural tension is performance-enhancing is probably just a matter of opinion, but I do find some interest in thinking about whether improved technical precision in a musician is worth the (questionable) alleviation of emotion that can make a piece great.

  22. Anonymous8:56 AM

    Beta blockers are what gets me through practical exams in dental school.

  23. Anonymous6:29 AM

    I found another great use for beta blockers: beeper call from home. I don't mind the adrenaline rush before exams (I think that helps me do better), but I absolutely hate the tachycardia after my pager wakes me up just as I am falling asleep... and 30 minutes later again... and 2 hours later again.