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.

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.