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.

Tuesday, March 13, 2018

SOAP

I didn't match. Not the best way to come back to blogging after a 1+ year absence, but it is what it is.

I've been silent on here because I didn't want to post grumpy, sad things all the time. No one wants to read that. I was hoping to finally have some happy news after years of stress. But alas, that didn't happen and here we are.

To give some background to my story, I applied into ortho with low step scores (sub-230) and four interviews, so this didn't come as a too much of a surprise. Regardless, it still sucks.

I had a bad feeling about yesterday. I realistically only had a shot at one of my four interviews* (let's call it Program A) and when I sent them a "You're my #1" email, I got a somewhat noncommittal response. So I knew it was coming.

Having said all that, there were some reasons to be hopeful. My chairman is really good buddies with their chair and placed a call for me and our program director is also close with another attending at Program A. Both said that Program A had contacted them about me and said that they really liked me, I did a good job on my away, blah, blah, blah. I also met Program A's step cut-off, which is a rarity with my numbers and the competitiveness of ortho. Everything that could go in my favor was seemingly going in my favor, but unfortunately it still didn't work out.

So now I'm stuck going through SOAP, hoping to match a preliminary general surgery position and trying again next year. I was advised to try for Program A again because I had such a good shot this year and probably just barely missed the cut. I resisted at first because I figured if they didn't want me the first time then there's no reason for them to want me again. I equated it to a bad breakup where no one ever goes back to their number 5. A friend reminded me that if I'm using relationship metaphors for Match, then this should be considered a polygamous marriage rather than a monomagous relationship since they keep coming back for more every year. So I wisened up and at the last minute added Program A's prelim spots to my application list.

Now I wait.

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* My interviews were at my home program (which flat out told me they won't take me because of my Step score), at an away that also had a hard Step cutoff that I didn't meet (I didn't find this out until the first day of the away), and at a very popular northeast school that for some weird reason offered me an interview.

Wednesday, November 30, 2016

Breathing new life into my sails

Right after the my funk/MDD episode/all-time medical school low point, I started OB/GYN. As the rotation went on, I slowly climbed out of the deep hole I had been in earlier in the fall. It was the babies, the procedures, the surgeries, the patients, the Spanish. I felt like every day I was fresher, happier, and more optimistic despite the exhaustion, frustration, and disorganization that characterized this rotation.

OB/GYN fittingly ended on an incredibly high point. This is what I posted on my personal FB wall after my last L&D shift on my last day of the rotation:

It's easy to get down and lose perspective in the day-to-day grind of exams and evaluations during medical school. But then I have a day like Saturday where I delivered a baby girl into this world and unwrapped the cord from around her neck. She breathed her first breaths in my arms and a wave of relief washed over me with each one of her cries. Not only was she seemingly healthy but I hadn't dropped the baby!

As much as third year has been a struggle, moments like these make me realize how incredibly lucky I am to be doing what I love.

Even though I most likely won't go into OB/GYN I will always look back on it fondly.

Saturday, November 26, 2016

Internal medicine from a future surgeon's perspective

I've been on internal medicine this month and I've surprisingly loved it. For the first week, I even considered it as a career.* But then the future surgeon in me would rear its head.

For example, I was discussing plans for discharge with my resident. The patient had come in for stomach ulcers after taking too many NSAIDs for her bilateral knee pain (arthritis).

Me: "Last problem is pain management. I discussed avoiding NSAIDs and taking Tylenol instead."
Resident: "What would you do specifically for her knee pain?"
Me: "Bilateral knee replacement?"
R: "Not quite. Try again."
Me: "Steroid injections?"
R: "How about topical gel?"
Me: "Oh yeah, that could work, too."

Next time I should probably start smaller, at least while on this rotation.

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* Then we spent 5 hours rounding and discussing nursing home placements on a beautiful Sunday morning and that was the end of that.

Monday, August 22, 2016

Loneliness

I briefly hinted at this in a previous post, half-assedly promising I'd write about it further. Here it is.

If I could describe one feeling I've had throughout medical school, I would choose loneliness. I have never been surrounded by so many people and felt so alone.

Every day I go to the hospital, to lecture, to the library. I come home to a roommate. I bike with a cycling group and run with the November Project. I organize events on a group text. I host people for taco night, pizza night, happy hour.

Yet, I am so incredibly lonely.

Maybe I should clarify. I have no problem finding people whose ear I can talk off* but I cannot remember the last time anyone has invited me to anything or lent a non-hurried ear when I needed someone to talk to.

In fact, I was lamenting to a friend the other day that I'm really bad at planning things to do in town. She was surprised since she sees me as the planner of our group. I responded with, "That's because no one hangs out with me if I don't invite them to do something." She thought I was kidding, but I was quite serious. Another friend said she sees me as one of the most social people in our class. She's right in that I talk to everyone. What she doesn't know is I talk to people because I want them to talk back.

What prompted this post was the news that another medical student committed suicide last week (not at my school). People posted in our Facebook class group saying we should support one another and find the time to de-stress. All I could think of was, who do I call? The people who have already blown off my attempts at talking to them? Every time I broach the subject of my mental health or mental health in general, they try to change the subject or are visibly uncomfortable. They don't want my baggage.

Maybe my expectations for friends are too high. Maybe I shouldn't expect them to want to listen to me drone on and on about how much I hate third year or how I'm stressed because I cannot figure out how to get honors on my clinical evaluations. I get it. We're all struggling to adjust and get through day by day. The last thing they want is to talk about grades** or get dumped on by my stress.

Isn't that what friends are for, though? Shouldn't we support each other through thick and thin? It's so frustrating to have so many superficial friendships when all I long for is a connection with someone in my class. But everyone is too busy or too tired or only wants to be entertained. I'm not exactly a ray of sunshine these days.

Long story short, the last year has been really hard for me. I nearly quit medical school almost exactly a year ago, lived on the edge of passing my classes, had a season of intense verbal abuse as a rugby referee (the one thing that has consistently given me joy), finally decided to have shoulder surgery, got 10 stomach ulcers while studying for step (ibuprofen pre-surgery is partially to blame), then got a step score that may keep me out of orthopaedics. Now I'm struggling to get through each day impressing a different attending and resident on a weekly basis while feeling incredibly dumb and incompetent in the meantime. It's a recipe for disaster that realistically won't let up anytime soon.

For some reason, the last couple of weeks have been especially bad. I recently finished my psychiatry block so I can see the symptoms piling up. The good news is that I sleep well, I eat too much, and I look forward to most days (the ones I don't have to work). But I'm definitely not in a good place. I know that and I'm working to fix it.

In that respect, this is not a cry for help. I have a decent support network outside of school. Not ideal, but decent. I'm seeing a therapist once I figure out next month's schedule. Also, my roommate is the exception to everything I've written here. She's patient, understanding, does the dishes when I'm too tired to put my bowls in the dishwasher, and lends a fantastic ear.

She can't be everything, unfortunately, because a good chunk of my stress is school-related and she just doesn't understand. I wish I could find the medical school version of her, and I think part of my loneliness stems from the fact that I haven't found that yet even though I've put myself out there and tried. I have some good friends and shared some good laughs, but the elusiveness of that connection makes me sad.

To end on a positive note, I have a request. Please take time to ask your friends how they're doing. How they're really doing. Carve out an evening or a weekend, invite them over for dinner, and just listen to them talk. Shrink them, as I call it these days. They'll appreciate the gesture. I know I would and I'm pretty sure I'm not alone in that.

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*I spent 30 minutes talking to the administrative assistant for our neurology rotation, whom I haven't seen in over a month, because I ran into her in the lobby of our medical school. That's all it takes for me. I talk to everyone for a long time.

**I know grades are a taboo topic. I don't like talking about them, either. Anytime I've mentioned them has been in the context of learning from people who are doing well and figuring out their strategies because mine clearly haven't been working. I don't ask for scores, just advice. I think people are so averse to the subject that they don't see the difference.