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.

It's done

Almost exactly two months to the day of my first Step 1 nightmare, I'm done with this stupid test. I wish I had some uplifting story about my journey towards enlightenment, but currently I feel like crap.

The good news is that I'm pretty sure I passed. The not-so-good news is I'm not sure by how much. And for ortho, I need to pass by mucho.

I'm mostly beating myself up for getting the gimme questions wrong. Some were so blatantly easy yet I still managed to mess them up. And there were also three questions on one concept that I just couldn't remember the answer to even though it was super straight-forward. By the time I got the third nearly identical question in my second-to-last block, I seriously said out loud, "Are you kidding me?!" It was so frustrating knowing exactly where I could find the answer to certain questions without knowing the damn answer.*

I've been trying to put it all out of my mind since there's nothing I can do until my score comes out in July. But the way the last few days have been going, I don't know how I'll make it until then. Instead of pre-step nightmares, I'm having flashbacks of questions I missed that I should've gotten right and easy questions my mind makes up just to mess with me. It's been a rough few days to say the least.

On the other hand, I've always been a good test-taker and in the last few days of studying when I totally stopped giving any shits, my practice scores went up 10%. Who knows? Maybe I'll be very pleasantly surprised like I was with the MCAT where after nearly voiding the score, I scored well above my practice test averages.

One can only hope.

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* I'd brought a review book with me to the testing center as a sort of security blanket if I needed it. After getting the first question on this concept, I figured there's no need to look it up because they probably won't ask the same thing twice. Then I got it a second time. And again, I didn't look it up because what are the chances it'll come up yet again. Well, it did. Clearly my strategy was flawed.

My first Step 1 nightmare

I'm in the throws of studying for Step 1, in that we're one week into our dedicated study period, and I had my first nightmare about this beast last night. This does not bode well for my mental health in the coming months.

You see, I blew off medical school for the past year and half and, as a result, there are glaring gaps in my knowledge base. Couple that with the fact that I need a good score to have any chance of matching into orthopedics (my current love), and I have a lot of stress on my hands right now.

At the end of our block curriculum, I knew that I had a lot of ground to make up, but in order to see just how much, I stupidly took a practice test last week. It was a disaster. It was so bad that I spent the rest of the afternoon scouring the internet for success stories of people who pulled up their score by upwards of 50 points. Yeah, not many of those out there. So I fell into a hopeless funk and resigned myself to sucking hard-core on the most important exam of medical school. Not surprisingly, the rest of the day was a wash.

I managed to pick myself up from that mini-depression mostly by talking to a bunch of friends who have been through this before. Some confirmed my fears that I wouldn't be able to bring up my score to where I need it to be. But others gave me hope since they were in similar situations as this and managed to pull off a miracle. I work best under fear, so I'm hoping this is the motivation I need to really buckle down and study my butt off for the next month or so.

Speaking of months, I had originally set aside 6 weeks for dedicated period, which is more than sufficient according to nearly everyone. But since half of the first week was taken up by orientation administrative things and it's now been confirmed that I know nothing, I'm most likely going to push my exam back by a week to get 6 actual weeks of studying instead of the 5-ish I currently have. I lose a week of vacation, which would've been spent in the jungles of Costa Rica with my dad, but I'm going to need those extra days even if it's only to help my psyche and not so much my score.

We have a school-administered practice exam this Friday, so I'll see how much I've improved in the two weeks since my last practice test and make a decision then. But seeing how my question bank averages are going, the answer is probably not that much.

Worst case scenario, I push back starting rotations by a month to buy myself even more time. I'm pretty sure it won't come to that, but I really like knowing worst-case scenario outcomes. It keeps the stress from overflowing into hopelessness and being too overwhelmed, which is when I truly shut down. Just enough stress, and I'm super productive. But once it boils over, I may as well call it quits.

In the meantime, I'll try to keep my exam-induced neuroses to a minimum on this blog. I hope I come out of this with some sort of success story. Fingers crossed.

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Note: I'll post more specifics about my practice exams and other scores once I'm finally done with this thing, much like I did my MCAT. I'm not so much ashamed of my practice score, but more in denial about how poorly I did. I prefer not to see the number in print again until I've hopefully managed to overcome it.

An update of sorts

A lot has happened since I last wrote in May (!), as it should since eight months is a long time. The bullet point version is:

• Finished first year and block of second
• Spent a month in the tropics learning Spanish and sitting under a palm tree at many beautiful beaches
• Spent another month visiting family in the States and the motherland
• Officially started second year
• Felt super lonely in school*
• Made some friends
• Went to my brother's real wedding Stateside and fake wedding in the motherland
• Nearly quit medical school (seriously)*
• Got my life together (somewhat)
• Went into the holiday break passing all of my classes (barely)

Now here I am, within eight weeks of being done with our pre-clinical curriculum. It's really scary that in four months I'll be in the hospital, seeing real patients, and somewhat having to know what is wrong with them. I know there'll be heavy supervision and not that much real responsibility. I'll adapt and do just fine, but having to integrate and apply all this knowledge that has only been tested by multiple-choice is a bit intimidating. It's all very surreal as well as super exciting!

Before all that, though, comes the monster that is Step 1. For those not in the know, Step 1 is the first of three licensing exams in the US. It's the most important test I'll take in medical school because some of the more competitive specialties have relatively high score cutoffs for their residency applicants. Orthopedics is one of those, and seeing how it's my super duper #1 choice, I have to do kind of well.

Long story short, I took the "P = MD" (P for pass) saying a bit too seriously and have barely skated by in every class since anatomy. It's not that I don't know what I'm doing wrong to get these crappy grades. I just don't want to put in the work. Give me a threshold I have to meet, and I'll be a few points above it. Nothing more. Hence the "barely passing my classes" bullet point earlier.

This has been great for my quality of life leading up to this point (I've had A LOT of free time), but it's also put me behind when it comes to being prepared for the Step. I have a fair amount of ground to make up since I didn't learn most things well the first time. But it also means I have a sufficient fire under my butt to buckle down and get things done, which is how I operate best.

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*Posts about these topics are coming up. Stay tuned!