Sunday, June 9, 2019

My last move

Intern year is coming to an end and I could not be happier. Despite the awfulness and struggle of this year, it's a little bittersweet, partly because I have met some good people, but mostly because I hate change. Mostly, it means I have to move again, cross-country, for the third time in five years.

I'm moving to take advantage of an amazing opportunity in a fun city with lots of close friends, which is a nice change from this past year. I will be starting a job in orthopaedic research in a department that appears supportive of helping me achieve my goal of eventually matching into ortho at some point in the future. I'm excited for so many reasons, and I believe it's a step in the right direction both personally and professionally.

Having said all that, I've decided this will be my last move in pursuit of being an orthopaedic surgeon. If this doesn't work out or turns into a dead end, I'm done. I'm not moving for another research spot or another prelim year or another hope that things will eventually work out.*

I'm mentally exhausted from having such an uncertain future, and uprooting and relocating annually to pursue this pipe dream that may never happen has added even more stress onto an incredibly stressful situation.

What I've desired most throughout my entire life is stability and this is quite the opposite of that. This past year has taught me that there is more to life than work and I'm ready to prioritize my personal goals over my professional ones for the first time in years.

I still plan on busting my butt over the next year to impress my superiors and work towards an orthopaedic residency because ortho is what I really love and want to do. But I'm also coming to terms with the fact that the process of achieving that goal may not be worth it and that there will come a time to let that dream go.

I haven't gotten to the point yet where I'm ready to move on. I have a few more tries left in me but I also don't want it to come at the expense of my sanity. While I plan to pursue ortho for the near future, I'm also not going to keep putting my life on hold and sacrifice my personal life to the extent I did this past year.

While I cannot control my professional stability at this point in life, I am going to work very hard at feeling fulfilled and stable in my personal life, which is where the "No more moves" rule comes into play.

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* The exception to this is moving for a categorical orthopaedic residency position. That's about the only reason I would move away from my new city. That, and family. Family trumps all.

Sunday, May 26, 2019

Graduation tam

This week was my medical school's graduation so my social media is blowing up with peeps celebrating their accomplishments. I'm happy for them and all that jazz, but it brings back hard memories from my graduation last year.

You'd think I'd be upset about the fact that I was the only one of my friends without a defined career track or that I'd be sad to see my prelim year permanently documented in our graduation publications.

Nope. The thing that bothers me the MOST is the way I wore my stupid graduation tam. Seriously.

The proper way to wear it like this, with the hat parallel to the floor:

Image result for graduation tam

My millennial classmates convinced me to wear it similarly to the woman in this picture*, except even more angled and sitting even more at the back of my head. It looked like I had a freaking black starfish perched atop my cranium.

Image result for graduation tam

I regrettably obliged. Partly because I thought I'd look stupid wearing it the regular way (hindsight is 20/20), and partly because it seemed "cooler" at the time because the stylish people were doing it. Now, 1 year later, I'm still regretting it.

This is such a stupid thing to be upset about considering everything I've gone through in the last year and a half, but for some reason I just can't let it go.

Luckily, there are a few pictures before I changed my tam around and also others after I had realized my mistake and changed it back. But the pictures where I get my diploma immortalize my stylish "mistake".

I'm hoping some day I'll get over this because it is so. Damn. Silly.

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* BTW, I can't even find the way I wore it on Google images. Shows you how unpopular this way of wearing actually is. But I wasn't in the right state of mind to Google how to wear my graduation regalia prior to the ceremony. My only goal that day was to not break out in tears in front of everyone. 

ETA:
After I wrote this post, I found a picture that had almost the same tam positioning as mine (the woman on the far right). See, it looks ridiculous!

Tuesday, May 7, 2019

Progress

This whole year has been incredibly stressful not only because I've been worried about my future, but also because I've put an incredible amount of pressure on myself.

I've felt the need to be perfect in order to impress people at this program so they could advocate for me during the match. Every time I messed up that perfection (usually, only in my eyes), I would beat myself up about it mercilessly thinking I had blown my chance and the world was coming to an end.

Now that I haven't matched and I know I'm not staying here after the year is done, I've let all of that pressure go. It's been so freeing to not worry so much about the little things that really don't matter in the end.

For example, for the first time in my entire professional life, I overslept work. I woke up 10 minutes before our entire team (upper level, fellow, and attending) was supposed to start rounding. Obviously, I was going to be late, but I didn't rush in getting ready, I didn't speed, and I didn't jog from my parking space to rounds. I figured there wasn't much difference between being 10 minutes late as compared to 20. So, I took the usual amount of time and strolled in as we were talking about our 3rd ICU patient. With the exception of the PGY3 who had to hold the pager for those extra 20 minutes and unluckily got a consult in that time, no one seemed to notice. And I only apologized once, let it go, and went about my day as if nothing had happened

I'm not saying I didn't feel bad about being late, because I did and obviously wish I hadn't slept through the 4 alarms I set every morning*. But it was freeing to not feel guilty, angry, and awful about myself all day. When I'm at work, I kick ass and I think that speaks more to my character and work ethic than the one morning I overslept. It took me a while to realize that and it's been awesome.

This more Zen-like approach to my year has been so refreshing and I'm so happy I've finally reached this point. It makes my life less stressful and less angry at myself, which I sorely need right now.

I guess when you have bigger things to worry about, such as what I'm doing "next year" when really it's next month, the little things really don't matter.

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* I stagger my alarms for situations like this. They go in the following order:
Alarm #1 - It would be really nice to get up right now
Alarm #2 - I should get up if I don't want to rush
Alarm #3 - I really need to get up if I want enough time to grab things
Alarm #4 - OH SHIT, I'm going to late!

Sunday, March 17, 2019

Hindsight and regret

Hindsight is 20/20 and I am really feeling the truth in that statement these days.

My second attempt at the match went the same as the first in that I'm unmatched yet again. Looking back on how the year went, I have so many regrets about my career course. I blame some of it on myself (not doing well on Step), but I also realize I got bad advice from my home program and I'm paying for it dearly these days.

Back when I didn't match the first time, everyone (EXCEPT for my ortho chairman) said I should take a research year rather than do the prelim year. But I stupidly listened to one person rather than the whole crowd and now I'm paying for it. I've found there are more research opportunities for medical students than graduates and now I'm hosed in finding a job for next year. By graduating, I also didn't get a chance to do more aways, which I really believe could've helped me get a spot in the match (I was soooooo close last year after kicking butt at one program).

In an ideal world, I should've taken a research position after MS3. I honestly don't know why I didn't do it. I think I reasoned that no amount of research was going to make up for my Step score so why delay graduation if it wasn't going to change anything? I immaturely wanted to graduate with my class and unfortunately that was a large part of why I kept pushing through. I was also worried that I wouldn't get a research spot due to my Step score, which was partly true, but I should've tried anyway.

In retrospect, that research year would've given me the advocate that I'm sorely lacking right now. I need someone to make phone calls for me, to believe in me, to help me get a job. But my home program is not responding to my messages and the ortho PD at my current prelim position thinks I should give up on ortho entirely because I will never match. So I'm all alone in this world facing a really steep mountain I can't climb on my own, with no one to help me unfortunately.

I need to stop thinking about the "what ifs" because it's not going to change anything besides make me sadder than I already am. But it's also really hard to move on when I know a couple of decisions could've changed my career trajectory dramatically.

Now instead of being excited about starting an ortho residency, I'm wondering what kind of job I'll have in three months (if I'll even have one) and what other specialty I can imagine myself doing because that is a real possibility at this point.

This sucks.

Friday, December 21, 2018

Hope

I got an interview invitation! Holy crap, I didn't think this was actually going to happen but here we are.

There are many reasons to be excited about this, but mostly it means that my general surgery program director didn't completely screw me over with his letter of recommendation. I had been worried about what it would say because the month I rotated on his service, everything went to hell.

There was one particularly bad week where on Wednesday, the home ortho program told me flat out they wouldn't match me, on Friday my dad called to say his cancer had reappeared, and the following Wednesday I got into a car accident and couldn't get my car fixed because I was on day 3 of working 12 days straight. So I was way off my game.

To top it all off, my chief (my PD's pet) and I got in a tiff that unnecessarily spiraled out of control.* To say I didn't make a good impression on my PD during that month is an incredible understatement. As such, I'm pleasantly surprised that the letter didn't turn out to be ruinous, and in fact, got me an interview.

I'm also very relieved to get the invitation from this particular program. I had become convinced that I had forgotten to apply there because it's listed under a different name on ERAS. I was beating myself up about overlooking them because they have a baller research opportunity for people who don't match, and I figured it'd be hard to explain that I wanted to do research with them when I didn't apply to their program in the first place. Luckily, that is not the case and not only did I apply there, but now I'm even interviewing for a PGY1 spot!

All in all, I'm incredibly happy that one program is willing to take a chance on me. My program is also being really good about giving me time off to travel, so not only do I get to go to the pre-interview dinner, but afterwards, I get to hang out with friends I have in the area. It'll be really nice to see old friends and get some time off from this general surgery nonsense, and hopefully recharge.

And I'm super excited that all my eggs aren't in one basket. I kinda sorta maybe have options. There's hope!

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* It started as me asking him to stop being an ass to me, but more importantly, to tell me when people were being admitted from the OR and to communicate their post-op plans. He really didn't appreciate me "telling him how to do his job" and was very vocal about it. Our conversation turned into a yelling match (mostly him yelling at me) and ended with me crying in my program director's office explaining everything that was going wrong in my life that week (as mentioned above).

The whole situation was no bueno and the timing couldn't have been any worse as I had just asked my program director to write me a letter of recommendation.

Thursday, November 29, 2018

Feeling the need to be perfect

I realized that I've been so stressed for the past couple of years (ever since I started 3rd year in May 2016) because I've always felt I had to be at 100% every minute of every day. It's led to me beating myself up every time I get a pimp question wrong, worrying about making awesome plans for all 20+ of my patients, and just generally thinking I suck at life and my job. It's exhausting and completely unsustainable.

I've developed this weird mindset that I have only one chance to make a good first impression and there's no coming back from it. Therefore if I screw up on the first day or don't do things to my very high satisfaction, I assume that all is lost and there's nothing I can do to change it.

It started with 3rd year when I changed services nearly every week and every day was the first day of work. It continued through away rotations during fourth year for that very same reason yet even higher stakes. Because of my scores, I knew I needed to be the best med student / rotator they had ever met and it all began with that dreaded first impression that I thought I couldn't change.

Surprisingly, this same feeling has continued during my prelim year. I had hoped that by being in one place for a whole year, that pressure would disappear because I had a whole year to make good impressions and I could allow myself one "bad" day once in a while. But for some reason, it's persisted.

Part of it is the shortened time frame for everything...one month on ortho in July, needing a letter of recommendation from my PD by August, and switching services and chiefs every month. I've felt the pressure to be perfect at every turn because it's a new group of people and again, the stakes are super high (probably the highest they've ever been). Everyone has to love me on the first day, otherwise I have failed. It's a warped way to think of things and obviously has to change, because it's done a number on my mental health.

The problem with this way of thinking is that I can never be good enough in my own eyes and therefore I'm destined to "fail" (by my standards). I'm at a strong general surgery program, so all the interns have their shit together, which makes it hard to stand out among the super stars. In the back of my mind, I always knew I couldn't be top dog of the 15 or so interns in my class, but that doesn't mean I didn't put the pressure on myself to try to be the best. Of course, I had to be awesome on Day 1 and whenever I slipped up (as in intern inevitably does), I would get very upset and mad at myself, and would just spiral into self-deprecation, which would make me even more upset and the cycle would persist.

I realize I can't continue this way for the rest of the year because I have been absolutely miserable and it has affected every part of my life. I have to accept that I will make mistakes and that it's okay to be wrong. I don't have to be perfect because that ship sailed long ago and my fate is probably sealed at this program already.

What I can do is continue to improve throughout the year. I can go back to the basics of checking all my boxes, following up on labs and consults, and being agreeable and affable. I can give myself a break whenever I mess up or don't do something perfectly. I can accept the fact that I am not perfect and should not expect to be the best intern this department has ever had, because that's simply not possible.

My new goal should be to impress my bosses with my improvement and growth throughout the year. I won't strive for perfection, but I will strive for being solid and strong, and on an upward trajectory. Although rank lists are due in only a couple of months, I still have 6.5 more months with this program and I'm sure if I do all those things, I can get a solid letter at the end of the year for the next application cycle.

I keep wanting to throw in the towel because the first impressions have already been made and I've had a rough couple of months. But another way to get good evaluations is to show how much I've improved and that I can turn things around, and that should be what I strive to do with all the time I still have left here.

Saturday, November 10, 2018

Funk again

I feel like I start all posts the same way by saying things have been rough. I'm in the midst of orthopaedics interview invitations going out, and as expected, I'm coming up empty. I suspected this was going to be the case, but it's still very hard to see that I was right in my pessimism.

One of the programs that "ranked me very highly" last year and where I did an away last fall, sent out their invitations last week and I didn't get one. I wasn't very surprised because if they didn't want me last year, they probably weren't going to want me this year. But it was also my only other "real" shot at getting an interview this season and it's rough to know that now my options are even slimmer at matching ortho this year.

Additionally, my prelim home ortho program told me that it is "very unlikely" that I'll match with them, mostly because of my Step 1 score. I was hoping the programs that got to know me, either from aways or from this prelim, would be able to overlook my Step 1 and see that I'm a hard-working resident that gets along with everyone, because I knew my application would be screened out due to my scores. But it doesn't look to be the case and I'm really worried that I'll go unmatched again this year.

Somewhat understandably, I'm in an incredibly deep funk that I can't seem to get out of. I'm back to crying in inappropriate situations, such as at work, and shutting down to the point that I don't have the mental energy to do basic things such as clean, cook, or do laundry. I'm fully functional at the hospital and am surprisingly still kicking butt at my job (with a few teary exceptions), but that's about where my mental strength ends. Everyone keeps telling me to stay positive and keep my chin up, but it's really hard to be optimistic when I literally have ZERO interviews and thus no hope of doing what I'm passionate about.

What keeps me going is the fact that I'll be with my family in 8 days for vacation and it couldn't come at a more perfect time. I need the break from work, but more importantly, I need a hug. No matter what age I am, a hug from Mom makes everything better, even if only temporarily.

Wednesday, September 19, 2018

It's clear - I belong in the OR

I'm on a particularly hard rotation where I work even longer than usual hours, am writing way too many notes, and am running around several different hospitals all day. Being an intern, I never get into the OR.

But today was different. My fellow was in a super duper long case so I stuck around late to sign out to him. I eventually met him in the OR, where the patient started bleeding profusely through his dressings as we were moving him off the table. I held pressure to stop the gushing while they re-intubated, re-set up the room, and all that jazz. Once everything was under control, I asked the fellow if I could scrub while they re-opened the patient. The words came so naturally out of my mouth that I couldn't stop them. It was a no-brainer, literally. I am soooo glad I did because it lifted my mood instantaneously.

With ERAS opening up last week, I have been pretty bummed the past few days and have struggled to keep it together at work. I should be excited about this application cycle but instead, all those feelings of sadness from March and April keep creeping in. I'm terrified I won't match again and will have to settle for something else. I also feel incredibly incompetent at my job and keep screwing up, which my fellows and attendings have no qualms about pointing out. So it's been a rough few weeks.

For 1 hour in the OR today, though, even though I was doing the usual retracting, suctioning, and bovie-ing (read, nothing exciting), I was so content and even happy (gasp!). It didn't matter that I left the hospital at 11 pm or that I still had notes to write or that I truly hate (almost) everything about this current rotation, including the types of cases they do. I walked out of the hospital with a smile on my face and pep in my step simply because I got to scrub.

That's how I know I want to be a surgeon.

Tuesday, May 22, 2018

It's okay to be sad

The past couple of months have been hard. I would even extend that to a few months of sadness since the month leading up to Match Day was fraught with anxiety and stress. Since then, my life has been full of tears.

I’ve cried in places I never thought I’d be comfortable crying at, including multiple public parks, on an airplane, dinner at a fancy restaurant, on a catamaran cruising the Greek islands, during our class picture, in the school auditorium in front of my whole class, and the list goes on. By this point, I’ve gotten really good at crying silently, whether it’s in a public restroom stall or a car ride with friends.

I also stopped giving a shit if seeing me cry makes someone uncomfortable. Life is not all unicorns and rainbows and sadness needs to be normalized as much as happiness and the highlight reel of life that is splattered all over social media. This isn’t to say I cry in public to make a statement. I cry because I can’t hold in my grief any longer and need an outlet. A deluge of tears seems to do the job very well, if only temporarily.

Honestly, I don’t even know why I’m still so sad. I like to think that I’ve accepted the fact that I didn’t match and that I’ve made a plan for the next year to succeed. But every time I think I finally have things under control, a random comment or thought will trigger a wave of sadness and I feel the tears welling up.

So I’ve accepted the fact that I’m not over anything and allow myself to continue to feel the way I feel, only truly suppressing my emotions when absolutely necessary, such as during an important meeting with the ortho chairman (powerful men don’t like seeing women cry). Other than that, I embrace my sadness, let it all out, and hope that as the days pass, I will cry a little bit less.

When people ask if I’m doing okay, I don’t even bother with pleasantries anymore and go straight into, “No, I’m not.” Most times, I leave it at that but often I add, “I’m in a rough place.” Most people don’t know what to do with that, but I figure they should stop asking if they don’t want an honest answer (these are people who know my situation, not randos on the street).

I had a brief respite from sadness on vacation, where, for the most part, I was able to forget how shitty everything was going. I became an aunt (!) and the subsequent barrage of newborn pictures has brightened many of my days. I also spent some quality time in the motherland with family I hadn’t seen in years and relaxed for nearly a full week on the family homestead. It was soooo nice.

The peaceful homestead
Then I came back to reality where I had to pack up all my things, leave my best friend with whom I’d lived for 13 years, and move to an apartment I absolutely hate in a city where I know nobody. I had planned this early move before graduation to start kissing some ortho butt at my new program, get started on research, and start attending conferences to get my face out there before the onslaught of intern year began.

But these plans seem to be backfiring just as badly as my ortho dreams. The apartment I had rented on a house-hunting trip before vacation was supposed to be “luxury” and full of natural light but instead is dingy and dated*. The research coordinator is dragging her feet about getting me on a project and has stopped answering my emails. The general surgery coordinator said she will TRY to get me a month of ortho, although it’s not guaranteed (I was promised a month by the PD during my SOAP interview, which is the only reason I chose this program).

I know nobody at the morning ortho conferences and it’s weird to start introducing myself to random residents, especially since I don’t even know how that introduction would go. Am I a 4th year med student since I haven’t graduated yet? A future surgery resident? Either way, I’m still embarrassed I didn’t match and feel like I’m being judged every time I mention it, which is something I need to work on hardcore for the next month or so.

In short, moving early seems to be a terrible mistake thus far, taking me away from my friends prematurely and getting nothing in return career-wise but rather sinking me back into despair and hopelessness about my future.

I had made pretty good progress over vacation to the point where I would go days without shedding a single tear. But I’ve seemed to regress pretty hardcore with this move and am back to being incapacitated with grief at least once a day.**

As before, I’m working on taking things day-by-day, finishing everything I need to get done so I’m still a functioning member of society, and looking forward to July 1 so I actually have something to do with my days instead of wallow in self-pity.

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*Apparently in this city, they REFUSE to show you the actual unit you’re renting. I insisted on seeing something other than the model unit (which wasn’t even my apartment’s layout), so they very reluctantly showed me an empty unit that would resemble mine in trimmings and would be of the same quality as mine. Let’s just say that their definition of resembling my apartment is very different than mine.

**For those concerned about my mental health, I may be extremely sad but that’s about where my symptoms of MDD end. Well, I haven’t been sleeping much or eating well, and I’ve lost interest in some things (such as packing or caring what people think of my emotions). But I’m functioning as well as any fourth year med student, that is, I don’t want to do anything, and for the most part, get everything done that needs to be done. So overall, given the circumstances, I’m doing well-ish.

Monday, April 2, 2018

Next steps

The news is very belated but I SOAPed "successfully" a couple of weeks ago into a general surgery preliminary position. "Successfully" is an optimistic term because I can't bring myself to be too excited about a one-year position, and thus another year of uncertainty about my future. But I'm fortunate to have a job and to be moving forward with my life and career, so there's that.

I'm not even close to being over the fact that I didn't match ortho. Some days are better than others, but most days involve tears, and I'm not generally a crier. I'm also finding it hard to be optimistic about my future, at this point wondering if I can even manage to match general surgery next year and thus have any sort of career.

I've had a lot of lows in medical school and in life but I can safely say that this is the worst I've felt in a very long time. The little amount of confidence I had going into the match has completely evaporated and I've lost most of the hope I used to have in the medical establishment and more specifically, ortho program directors. I was told that crushing away rotations by busting my butt and being personable would help me secure a spot at a program, and I was too naive to believe that. In the end, I played the game wrong because no amount of hard work can overcome test scores from two years ago.*

I don't know what the future holds for me, and that's really unsettling. I vacillate between feelings of "I got this. I'm totally getting into ortho next year," to "Fuuuuuuuck. I don't think I even have a shot at general surgery." It doesn't help that the stats are not in my favor. The chairman at an ortho program I did an away at said I have a 3% chance of matching into ortho next year. That's very scary.

Everyone tells me I need a backup plan if I don't match again, with the most likely one being categorical general surgery. While there are parts of gen surg that I honestly do enjoy, I'm still repulsed at the thought of operating on bowels for 30+ years. I'm trying to keep an open mind because that seems like the most likely outcome and it's not a bad one. But I want ortho SO BADLY that not being able to do it is devastating.

I'm also somewhat regretting taking the prelim position. My Achilles heel was my Step 1 score and there's absolutely nothing I can change about that. I'm much better in person than on paper and in theory I'm really good at winning people over.** That's where the suggestion for the prelim position came into play. What I didn't think of was delaying graduation to do more away rotations and some research. It would've given me exposure to the program where I did research as well as my away programs. This way I'd have 4 chances to win people over instead of the single one I currently have.

I keep reminding myself that the prelim spot is the best path for me, but that doesn't say much considering it's the best option out of a bunch of really shitty options. On the plus side, with the prelim I have a whole year of the ortho department getting to know me instead of a month. I can prove without a doubt that I'd be an awesome resident (instead of a program having to extrapolate from my performance as a 4th year rotator). I can also slide into an ortho spot if any resident decides to quit. So there are positives...if it all works out. If I fail again, I'll always wonder, "What if?"

I wish I could end on a positive note but there's not much positivity in my life right now. My dean tried to cheer me up by saying I was ranked in the top 10 at my top program, but they just didn't go down that far this year. From talking to the PD, it sounds like they went to number 6 or 7 on their list (they take 5 residents) so I was 3-4 people away from matching. I know this information was meant to make me feel better, but it has the opposite effect. It hurts that much more knowing how close I was to being an orthopaedic surgeon and now I'm scrambling for any sort of career at all.

I know life isn't fair and in the end, I'll be alright. I'll have a good degree and I'll probably be able to get some sort of categorical residency position. But I (most likely) won't get to do what I set out for when I quit my previous career to go to medical school. It sucks that the dream I've had for 6+ years was crushed because of bad luck (and poor pre-clinical study skills).

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* This came out whinier than anticipated. I take full responsibility for not matching. I knew what I needed to do to be competitive (crush Step 1) and I didn't deliver. But ever since that test, I've worked really hard to do everything right, crushing Step 2, honoring most of my rotations, and kicking butt on my aways. I also know people with my scores who got terrible feedback after their aways ("none of the residents want to work with you") but managed to match because their orthopaedic surgeon father made a phone call for them. Like I said, life isn't fair and I knew this was coming. It doesn't make the outcome any easier to stomach.

** So I was told. See previous paragraph about losing faith in people.