What a difference a year makes

I recently came upon a text I sent about a year ago to a friend who had asked how I was doing. It really encapsulated what last year was like, both in content and in tone:

I'm in a much better place right now for so many reasons, and it makes me sad seeing my state of mind less than a year ago.

Throughout that year, I told everyone that at baseline I'm not a bitter and angry person, that the circumstances and the year had turned me into that. This text (and any time I talk about that year) are consistent with that point because I'm doing just fine these days, while that text is seething with negative emotions. The only difference is that I've moved because my future is just as uncertain now as it was back then.

The short version is: last year was TERRIBLE. I still have PTSD from it* and have had to unfriend/block people from Facebook just so I'm not reminded of how awful it was.

As soon as I left the hospital on my last day, I felt free. I was headed to a better place, both physically and emotionally, and I couldn't be more excited. Despite the fact that my future was no more certain, at least I was leaving a situation that was destroying my mental health and was bringing me no closer to my ultimate career goal.

These days, I'm living the good life. I'm doing a research year in orthopaedics in a program that appreciates me with several attendings who said they'll do everything in their power to have me match. I'm cautiously optimistic that it'll work out, but I'm also realistic about my chances and don't truly believe that I'll get happy news in March. But at least my day-to-day is SO much better.

It's taken a while, but I've rediscovered the things that make me happy...and finally have time to do them! I've taken up hobbies I hadn't done in years. I have friends. I've taken road trips. I still work long hours, get up well before sunrise, and continually worry about what people think of me and what the future holds. But the work is interesting, everyone is kind, and I don't feel like the thorn in anyone's side.

It's been <6 months since I left my previous program, but it feels like a lifetime. I don't even recognize who I was back in June, although those scars are still there and will take some time to completely heal.

I am so grateful to have ended up here. I needed this year not only to get closer to matching ortho, but also to regroup and rediscover who I am. I had completely lost myself over the past couple of years, and felt like a shell of who I used to be. It's been slow going but I'm starting to get back to being me, and it feels so good!

In short, life is good today (and this entire year).

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* That's a post for another day, but it's coming.

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.

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.

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 4^th 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.

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.