Guess who's back?

Firstly, pardon the radio silence for the last 5 years. It's been a doozy and, for the most part, a really shitty experience, which is why I've kept silent on here because I didn't only want to write about doom and gloom.

But now, the light at the end of the tunnel is so freaking bright and I'm less than three months away from being completely done with training.

Most importantly, I'M AN ORTHOPAEDIC SURGEON!

Graduating residency last summer was so surreal. So many people told me it was never going to happen and the crap I went through in residency made it feel like I wouldn't make it to the end. But I did. And I have the diploma to prove it. It's by far my greatest accomplishment and some days I still can't believe it's true. But it is!

Although I'm technically a full fledged attending with an independent medical license, I'm still not entirely done because I'm in my last year of training finishing up a one-year fellowship. Even though fellowship is so much better than residency, I'm not fully in control of my schedule so I still feel like a trainee. Regardless, it's so incredibly freeing to know that this extra year is totally optional and that I can quit at any point and still have a career as an orthopaedic surgeon. And that freedom makes everything so much better.

So what's next? After I graduate in July, I'm headed back to my hometown to live my best life. I still don't have a job because the job market is super tight in my subspecialty, especially in my hometown, and I've chosen to self-limit my job hunt to that particular area. So after all of this blood, sweat, and tears, I've added on a little bit more anxiety 

Why add the extra stress of joblessness and not expand my job search? Frankly, I'm tired of moving and want to settle down for good. I want to be able to grab dinner with my parents on a Wednesday night instead having to fly to see them. I know that I want to end up in my hometown long-term, so it doesn't make sense to go somewhere else for a couple of years while I keep looking for a job back home. I'd rather stress now and work at Starbucks (as one of my mentors said), than live anywhere else after finishing training.

I have some ideas for Plans B, C, D, and E if the job thing still doesn't work out anytime soon, and will try to share them with y'all. But for now, know that I haven't forgotten about this blog, and that things are really freaking good right now.

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.

---

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.

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.

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.

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.

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.

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.

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.

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.

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.