Moving forward

Another year of residency over, and I can't quite put a feeling to it. It's weird finally progressing in this medical path, rather than treading water or feeling like floor will fall out from under me at any time.

All I've ever known as a resident is how to be an intern (or a research assistant, which was surprisingly similar to being an intern). And now, that's over, and I truly can't believe \that I will never, ever, in my entire life be an intern again. It's so surreal.

No more SICU, no more trauma, no more NG tubes, and no more abusive General Surgery scheduling (if you couldn't tell, I HATE general surgery). Also, no more floor pager, no more dispo meetings, and the list goes on.

With the whole not matching thing (twice), I've felt like I was in purgatory for the past several years: busting my ass but getting nowhere. Same responsibilities (or lack thereof), same bitch work, same shitty schedule. And the same need (and resulting anxiety) to impress everyone because my career depended entirely on what others thought of me.

But now, progress.

While my schedule won't get too much better and the bitchwork will continue for a while longer, things feel SO MUCH different.

I'm one year closer to being done, and that fact alone makes all the difference. With every year that I didn't match, the finish line kept getting pushed farther back and was, at times, impossible to even see.

Now, I will ACTUALLY be an orthopaedic surgeon...in 4 short years. It's so exciting and terrifying at the same time.

23

23. That's how many days straight I am working. No days off, no 24-hour consecutive periods where I'm not at hospital. Instead, I've switched from days to nights to days again and have been at the hospital every day for the last 23 days, working at least 13 hours during each of those shifts. I have no freaking idea how there are zero duty hour violations.*

I am, unsurprisingly, grumpy.

It wouldn't be so bad if I was actually doing something during this time. You know, the usual intern things like working up floor issues, doing discharges, closing when I'm in the OR. But unfortunately, I'm at a program that gives more responsibility to its medical students than interns. It's incredibly frustrating, especially since I already have an intern year under my belt so I don't need the "practice" of being efficient at floor tasks and other basics of doctoring.

Last week, I was in a 12-hour OR case. I can count on one hand how many sutures I threw at the end of the case before the attending took the needle driver from my hand because it was getting late and he wanted to speed things up. "Let me close up so we can get out of here at a reasonable hour," were his exact words. I wanted to punch him in the face right then and there.**

Maybe I have unreasonable expectations about my role on the team. At my first intern year, they handed you the pager and said, "Good luck! Call me if you need anything," as they signed out a 50 patient list and peaced out. Here, you have to text the senior every time you place an order, including melatonin. It's absolutely ridiculous and incredibly frustrating, especially since I've already done this once.

But at least at the end of this stretch, I'll have some vacation and quality time at the beach. So there's something to look forward to even if I have steam coming out of my ears right now.

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* Somehow this doesn't violate duty hours, which blows my mind.

** He had sent me out for a break 7 hours into the case, and I was so hangry at that point that instead of grabbing a quick food and bathroom break and being back in 15 minutes (like I had initially intended/a good intern would do), I grabbed food from across the street, plopped down on the grass outside the hospital, and soaked up some vitamin D. I had zero regrets or shame when I strolled back into the OR 45 minutes later. In retrospect, I feel even less shame now that I know that this case contributed ABSOLUTELY NOTHING to my learning and my attending didn't even notice I was missing since by that point he was working under a microscope and I was watching unscrubbed on a monitor.

Supported

There is no way matching would've been possible without everyone's support, both from the medical community and outside of it.

I'm also so incredibly thankful for your anonymous comments, cheers, and prayers from afar. Despite not knowing most of you in real life, your virtual support has not gone unnoticed. Things have been pretty dark for me for the past few years, and your belief in me kept me going when all hope seemed to be lost. I truly appreciate you for sticking with me and offering your thoughts over the years.

I have been showered with more love and support these last few weeks (and even in the weeks leading up to Match Day) than I could've ever anticipated and there is no way I could ever repay it.

Thank you, from the bottom of my heart.

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As a sidenote:
I bought this mug last year when I was in a huge funk as a reminder to keep trying despite all the setbacks. (It also perfectly exemplifies my stubborn personality.). It never failed to put a smile on my face, even during the most stressful and hopeless times.

Now it's a reminder of what I have accomplished and how determined I can be when I set my mind to accomplish something. Story of my life. Now, not only does it bring me happiness, but also immense pride for accomplishing the seemingly impossible. Success is the sweetest revenge, as they say, and tea tastes so much better when coupled with that.

Third time's the charm!

I can't believe I didn't post this sooner, but the email I had been waiting for for years, finally arrived (more than two weeks ago now).

(I recognize the timing of this post may be a little suspect, but I assure you, this is no joke.)

It's taken a long time for it to sink in, but finally two weeks later, I think I've finally accepted that this is real. For the week or so after matching, I had to keep repeating to myself that I had matched. Seriously. I didn't think this was ever going to happen, so it was so surreal to have finally gotten in. Even now, though, it's still so strange to think that in 6 years time, I will be an orthopaedic surgeon.*

It's mostly strange to have an end goal, a finish line, a concrete timeline. I have lived in this migratory purgatory for so long, not knowing what the next year will bring and having to constantly move to keep chasing opportunities, that it's strange to have stability for the foreseeable future.

I'm going to be in one place for 5 years (!!!), with the same people who will be invested in training me and helping me become the best damn surgeon I can be.

Over the years, getting to do orthopaedic surgery had become this vague idea that I wasn't sure was actually going to happen, like this elusive thing that was always just out of reach. But now it's real, concrete, and so incredibly (but pleasantly) strange.

Oh, and I don't have to move. I matched at the program where I'm doing research. Woohoo!

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* I'm anticipating doing a 1-year fellowship, like the vast majority of orthopods these days, hence the extra year of training.

Denial

Tomorrow is Match Monday, the beginning of Match Week, round number 3 for me. Honestly, it feels like any other day and I've had to put it into my calendar otherwise I'd forget the big occasion.

This is in stark contrast to the first (or even second) Match Monday, when I had a countdown on my phone, was constantly thinking about it, and had to actively distract myself with other things.

This time around, I keep forgetting that it's so soon...as in, tomorrow.

I think part of it is due to being desensitized from the previous times I've had to go through this. None of the experiences have been positive, and have in fact been pretty traumatic. This process has become routine (apply, interview, wait) and the outcome will probably be the same, so the element of surprise has worn off.

I also can't believe it's already March because this year has been gone by so quickly! With every passing week, I have looked forward to the weekend where I could explore my new surroundings and enjoy having 2 days off each week that I could fill however I wanted (such a foreign concept to me, which is sad in its own way). The passage of time has been a pleasure and there hasn't been anything I've dreaded like I had in previous years. It's been a nice, positive change.

This whole process doesn't feel real, either, since I'm so far removed from the residency application process in that I'm not surrounded by people talking about it all the time, like I was as an MS4. It's a cloud that hangs over me constantly, but is rarely talked about since most of the people I work with don't understand the process and everyone else has bigger things to worry about. So it's odd that it's actually happening.

In short, I'm in super denial about the email I'm going to get in about 12 hours that will change everything or nothing, depending on how the cookie crumbles, as my boss put it.

Hopefully it'll be good news this time around. Fingers crossed.

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.

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:



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.



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!

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!

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.