Conventional Wisdom from Hot Urologist: More Than a Board Score

Months and months ago, I walked into the same Starbucks on City Avenue at 6:15, just prior to giving a pap smear for the first time to a volunteer patient (true story, god bless that women's soul, amongst other things).  It would be the day I first encountered unnaturally hot, super thick-blonde-haired urologist from Einstein.  I didn't know his name (now I do), but we talked for a moment. He was in his fifth year of urology residency, something I learned later was a polite way of saying "chief resident" without shoving it in your face, like when people say they "go to college in Boston" but we both know what that means.
H.U.: "Are you a third year?"
VW: sheepishly (<<<----not entirely sheepishly, I just like the opportunity to use that word), "uh, I will be if I make it through this year."  Two can play at this 'guess my actual position on the medicine totem pole' game.   Actually mine was pretty obvious.  The short coat always gives it away, and I'm pretty sure I need to pack on 10 lbs and lose the makeup before I start to look like a resident.
H.U.: "Second year's rough. Boards.  It gets way better though; everyone tells you that and it doesn't really mean anything but you'll see."
VW: "Cool, I'll hold you to that when I come work for you."  wtf?  God VERONICA YOU ARE SO CREEPY RELAX.


Fast forward half a year, and hot urologist was right, after boards it DID get a lot easier. In a way not unlike the Kubler-Ross model of grief, I went through five stages, give or take.

1. Denial:  I don't buy it.  There's no way an 8.5 hour exam can be all about endocrine and Calcium.  There's no way.  They have to have been secretly asking about chronic myelogenous leukemia or polycythemia vera.  They wouldn't make an all endocrine test.  That's crazy.  No.

2. Anger: WHO MAKES A USMLE ENTIRELY DEDICATED TO ENDOCRINE.  WHY DID I EVEN STUDY ANYTHING ABOUT VAGINAL BLEEDING. HELLO, WHERE WAS ALL THE MICRO?  DO WE JUST NOT CARE ABOUT STAPH NOW?  YEA, EVERYONE, JUST SO YOU KNOW WE DON'T GIVE A RATS BEHIND ABOUT ANYTHING REMOTELY APPLICABLE TO MODERN DAY MEDICINE, OK. This is the worst.  I hate everything.

3. Bargaining: "Hey God, it's me, Veronica again.  I swear, I will literally join the convent and dedicate my life to you if you somehow make the Prometric testing center explode without human casualty during this exam and accidentally rig the system to give me >240."

4. Depression:  so little sleeping, so much ice cream, lots of nervous "hope I'm a doctor, hopefully, ha ha" jokes.

5. Acceptance:
Anyone else: "How was USMLE/COMLEX?"
Me: "Awful, I wanted to die.  Nothing you prepare for is on there. But in general pretty okay!"

I digress.  So here I am, post-boards, pre-score, but emphatically, post-boards, waiting for my latte that is probably the reason I have a hard time budgeting my student loans, and through the doors saunters in Mr. Hot Urologist Long Coat. But before the costume even gives it away, I think, God, that guy looks familiar, and I go through the mental forensic profiling match I keep in my head.
1) That guy is from Tinder.  NO. (It was a dark time when I became newly single). We don't like Tinder.
2) That guy is Hot Urologist.
3) Dude, Hot Urologist is on Tinder.  Yikes.

I'm sure he sees this moving montage/algorithm on my face as clear as day, so I take my thoughts elsewhere.  I read creepy like white on rice. Anything, think of anything.  Uh, puppies.  Campylobacter. Trisomy 18.  Scrubs Season 5 and how disappointing it was.  Laundry I didn't put in the dryer.  What am I going to eat in 6 hours----

H.U.: "Today's my last day of residency."
VW: "Exciting!  Good for you."  It worked. He's not on to you.
H.U.: "Second year, right?"
VW: "Actually, third year.  I made it out alive.  Well, [cue the self-deprecating defensive humor], I guess it depends.  I just took my boards."
H.U.: "Awesome, they're no joke.  What do you want to do?"
VW: "I guess it depends on my score."

And as you might have guessed it, the crux of the moral is manifest here.
Hot urologist vigorously shakes his head; I can tell he's bordering upon a "tsk, tsk" and finger-wagging.
"I didn't ask what you got, that doesn't matter.  What do you WANT to do?"

And before I begin my diatribe to explain that, yes, in fact, I believe my score dictates a lot of what I can and can't do, I also give myself some pause.  A lot of what I "can" or, perhaps better put, am academically qualified to do is premised upon a score.  But Hot Urologist is right, it's not the only thing, and while it's the most standardized way, it isn't the only way.  So I answer him truthfully.

"I want to do Internal Medicine.  I like adult medicine.  I like a little bit of continuity of care, but I'm afraid I might not see as...'ill' as I'd like with just Family, although I considered that too.  Honestly, gun to my head and I had to decide today, I want to be a hospitalist. It's my dream.  It's what I want."

H.U.: "You poor bastard, you'll be worked to the bone until you die/retire.  Good for you.  It's not just your scores, don't let anyone tell you that.  I'm telling you that.  Good luck."

And part of me hopes he's truly right.  Not just because his frankness makes hot urologist even more mysteriously attractive, and not just because I feel it's a fallback excuse for substandard performance, should I not get my target score (read: passing.  In case you haven't noticed over the past two years, a lot of my targets tend to gravitate towards making sure I don't fail).  Mainly, I hope he's right because, in much the same fashion I deliberately chose to apply to and attend as Osteopathic College of Medicine, one that preaches and practices looking at the "whole" patient instead of just pigeon-holing their problems into symptomology (made that word up, don't try to google it) and differential diagnoses, I wanted to be looked at wholly, and thoroughly, and completely too.  I want to be seen as competent, which hopefully is substantiated by my boards, but irrespective of those, I want my future attendings and residency programs to see me as Dr. Williams, the resident who is so bothered by not knowing the why  of your presentation that I'll let my OCD take me to the depths of Harrison's at home and I'll look it up until I can teach you all about acute appendicitis.  I want them to know I am a trained painter who loves portraits, because of the attention to detail that is required, and because I genuinely feel art and it's application on a painted canvas is a way of telling a story about someone, and I am so interested in everyone's story.  I want them to know I run miles and miles not because I ever give two hoots about my weight, but because I do all of my thinking and problem sorting when I run, and I believes humans were meant to move.  And most importantly, I want them to know that, although medicine was a dream realized a little later than most of my peers, I still, every day, want to be doing it.  I want them to know that I would sleep in a car 5 summers over and over again.  I would remediate physics, again, for the third time, to be here. I would overdraft my account by 20 dollars and cry into the Washington Mutual phone again and again and beg for a fee waiver just to pay for another AACOMAS application. I would fail Dermatology in medical school again, study for 1 week straight while everyone was already on spring break, and never have a sense of bitterness about it, just because it meant I could keep going, and now, I know Derm like nobody's business.

That, hot urologist, is what I want you, and all attendings just like you, to know.  I hope you're right, but really, I hope you don't even need to be.

Navigating Limbo of (1/2) DO; Reintegrating Into Society

I often joke about my personal frequency of existential crises as a shiny new third year medical student. As if, in a way, publicly acknowledging them makes them punitive, a type of correctional reinforcement for myself to stop being so petty and get over myself, as if what I have done in the last two years even remotely has any bearing on what I do when I actually get out to do it: in a hospital, with patients who are not robots, with preceptors that are a little less forgiving and rightfully more demanding.  And in a way, many of my cynical humors are well-intentioned, but they are nonetheless pervasive.
I spend a good deal of time losing sleep, partly due to a regrettable $99 mattress, the rest likely attributed to this feeling of self-doubt, that, like these springs with lost recoil but still find some way to jab between every individual rib, remains unrelenting. Keeps me awake, keeps me unsure, keeps me anxious when I would rather be dreaming.  I urge you, at this moment, to suppress any immediate feelings of pity, or eye-rolling annoyance of “god-this-naïve-young-half-doctor-who-hasn’t even had the chance to nearly kill someone yet, let alone be publicly crucified for not sending the fax correctly.”  Mainly because that’s not the point of this little testimony. As most of my medical school musings have shown, I write when I need to think aloud, when my hands do the sorting for my mind. That, or I paint, but I don’t feel like getting my hands dirty at 4:30 in the morning.
But I write this piece predominately because I find it imperative to articulate what a lot of people (presumably) in my situation have felt a million times before, but have had a difficult time conveying to whomever asks; those who want answers, even out of trivial benevolence.  To clarify, I mean our families, or our friends, who “want to know how you are doing?  Where have you been?  Tell me about what’s happening in school?  When do you get your scores back?” and so on.
Again, please don’t think I’m here to lecture about the necessity of “leaving us alone” because of the “gravity of what we are doing,” or how sitting here in a 2 hour didactic followed by a lesson on how to do a venipuncture is clearly so much more taxing on my brain and body than your 9-5 and how could you possibly understand. No, in fact, quite the opposite. But it requires patience from you, as the reader, so bear with me.
I write because, I feel that it is hard, even now, to accurately describe the type of distance you feel as a medical student: between you and your peers, between you and your material that you have not quite drowned in, but somehow keep your nose above water, between you and your faculty, who in some ways, can no longer help you, and more importantly (for me), between you and The Outside World-your friends, the general public, the romantic partner.
It is a distance not so easily remedied by merely interacting with colleagues or friends, by active club membership or a prescription of SSRIs, or “positive thinking” or yoga or alcohol or insert-your-favorite-recreational vice here.  Again, the undertone of this isn’t meant to solely imply melancholy, but rather, to show that some of it is natural, woven inherently and somewhat implicitly, insidiously into the nature of a medical school curriculum.  It is partly unavoidable, transient, but most certainly, present.
Like every story deemed worthy of sacrificing valuable REM to, this one has an impetus.
At a dinner with a young man not long ago, I tried to describe what it feels like to truly sit back and realize that you are on a career trajectory that has decided much of your “fate” (I choose this word lazily), for you.  By that, I don’t necessarily mean specialty….but then again, yes, I kind of do.
From the day you begin medical school, a 2 year long calendar that most of your peers don’t know how to access on Nucleus is available for you to view.  From there, you see every term’s beginning and end, every holiday you’ll ever get off (and after 2nd year, will never get off); every fee deadline and every grossly inaccurate loan disbursement approximation.  You begin as Student Doctor OMS-1, and can essentially see all the way into the future, pending no major failures, psychological breakdowns/leave of absence, etc. And you know what to anticipate: the hard work, the certain addiction to some caffeine or other stimulant, the late nights and early mornings, the overreactions to B’s and C’s as a first year and the complete turnaround attitude of being totally underwhelmed, thinking “who cares JUST SHUT UP ABOUT GRADES THAT DON’T MATTER AND LET ME STUDY FOR BOARDS FOR GODS’ SAKE”-this monotony and anxiety that prevails in second year.  And then you take the GREAT EQUALIZER: the COMLEX, the USMLE, or both, if you can tolerate 16 hours of testing, and then: so what.
Then you wait.  And ironically, this tangent has nothing to do about awaiting scores. Like anything else, I know they will come, and will be set to some scale that dictates what doors are closed and which others are opened, but at the end of the day (the year, the years, the year 2018), I still get to be a physician: the ultimate dream actualized.  On top of that, I get to be a Teaching Fellow.  So not only am I still seemingly typing without purpose, I’m nearly complaining when I should be grateful. The point is coming, don’t worry.
But it is more than that.  It is trying to tell whomever sits across from you at this sushi restaurant, or at home, or on the phone, that in many ways, medicine forces you to learn a language that now, only a few of you speak.  Your experiences, whether you like it or not, predominately revolve around you and 200-something people just like you, doing what you are doing, all the time, 24/7.  And while the gratitude never, ever goes away (hopefully), sometimes something else does-some part of you-and I believe you would be hard pressed to find a medical student who disagrees, if they truly took a moment to consider it.
Imagine actually trying to care about your future in the ways most “normal” people do.  Imagine trying to convey to someone that you’ll be leaving for 4 years (now 5, because you’re clinically insane and enjoy pre-doctoral fellowships), and maybe you’ll come back, or hey, maybe not, it’s really up to “THE BOARDS.”  Or what it’s like to pack your vacation so full of things to do in 14 days for the one and only year you’ll get it that you spend more time allocating each’s days activities amongst different parties of friends/family that you aren’t even sure WHAT day it is, and in some ways, it confers this metallic, bitter taste to your mouth that is synonymous with “vacation” when all you wanted was to melt into nothingness without reprimand for being selfish.  Whether or not you are actually chastised for this behavior is besides the point; it’s the nagging Catholic guilt that tells you what you ought to be doing with and for others, instead of compulsively looking up Expedia flights to St. Martin because, god knows how long your grandmother has left, or that you should probably go back to the West Coast to show some appreciation to the person that bailed you out of all those college overdrafts.
Or what it’s like to tell someone on a date that there is no permanence to your situation, necessarily.  That you would like to stay here, but things are unclear.  Or that you would like to move there, but, I mean, this is just a date, or you are just a significant something or other, and this is by no means implying that every future decision you make regarding residency depends upon them, but it certainly doesn’t factor them out, because, well, you are a liar and a fool if you think the choices you make in life don’t, in some way, consider the beneficence of others (but moreoften than we would like, the beneficence of ourselves). The heart is greedy, and in a way, that’s a good thing.  If every decision we ever made was purely clinical, truly devoid of passion and fervor, we would be excellent diagnosticians, but incredibly poor practitioners, nay, artists, of medicine. All talk and no flavor.
But for a moment, imagine the guilt you might feel when you have so little to offer to the conversation of a ‘normal person’:  how everything you do, actually, yes, is in fact about you, and that you would love to hear about your friends’ wedding, but you haven’t slept in three days, so maybe she could email you?  Or how, on this date you’ve had for the 10239102380th time you just want to say, “I have made a very definitive decision to practice general medicine because it affords me the flexibility to work wherever, because, no, I actually do not want to be an unmarried surgeon in rural KY at an elitist program.  Because, no, that would never make me happy.  Give me all the general medicine, please.” But, you don’t, because that’s not what normal people talk about. Because it would add this unnecessary solemnity or intensity to a situation that is inevitable, a conversation that always comes up but is almost forcibly avoided. So what do you talk about instead?  What good acting skills do you summon from your ironic Bachelor of Arts in Theater to pretend like you can engage the general public?
They talk about what’s on TV on the cable you don’t have; they discuss what their kids are doing now in school and you nod your head ‘knowingly,’ pretending like having done a rotation in pediatrics makes you equally qualified to listen to this.  You want to FaceTime your friend, but by the time you pick up the phone, you realize it is now 5:50AM, and the last time you went to bed was now, two days ago, and you need to go to the gym, and take a Xanax, and read OMM because you have one Board left.  And it’s funny: none of this is an impossible, monumental task.  None of it.  It’s a lot, sure, but not impossible.  But what it is, is isolating.  And although it is just part of the routine, don’t let anyone lie to you and tell you otherwise.  How you navigate it is a personal choice, and some days it is so easy to put it aside and hop on a plane and forget all about it, and other days, it will be the reason you write a breathless essay about it, on the gravity of a situation that is very manageable, but nicely packaged and sequestered far from the outside world, behind a lot of books and laptops and short white coats. I wonder, when I finally put on the long coat, if I will muse about this and laugh that I ever let it bother me, that it ever kept me up at night, or rather, if I will just force myself to forget about it.  I wonder.

evidence of life: post boards, with Kelsey being a human again, with my fellow fellows Kevin and James, and post gyn skills with Grant, who is not blushing at all.

Primary Insufficiency: being enough when you feel less than

I must have started this post 4 or 5 times in the past 3 months and somehow couldn't complete it.  It just wasn't the right time, I told myself.  There were no major life-changes, no astronomical ups or downs worth documenting, nothing out of the ordinary.  Getting by per usual, I felt that the second I sat for my exiting final for a class worth next to nothing (unit-wise, not life-lesson-wise), I had already begun the next. GI blended into RGU, Surgery somehow haphazardly thrown in the mix, RGU blended into the world's shortest break, Sunday of break turned into Rheumatology, Rheum somehow became Endocrine, Endocrine gave way to Dermatology.  And in the midst of it I studied per usual, I ran per usual, I sighed heavily per usual and ate my way through a hundred kit kats.  I signed up for the COMLEX, and then the USMLE.  I ran a couple races, painted some new pictures, saw 1093120983102983120398 people on Facebook get engaged (c'mon guys.  Where are all the Halloween engagements.  WHERE?), logged into Blogger, but couldn't type.  I just felt robotic; content, okay, normal, complacent, surviving.  It felt familiar, kind of like last year.  In fact, exactly like Winter of last year.

But then I did something stupid, or rather, just different.  I agreed to attend a holiday party the evening before my Endocrine final. In my mind, this was perfectly logical.  I had studied harder than I usually do.  I was doing COMBANK questions like I would die tomorrow and somehow still be charged for my subscription. I read BRS and consulted faculty and talked through stuff with people that knew better.  I was ready, and so, I would take the night off, and actually sleep.

And I DID do just that.  I had drinks and was merry and took pictures and left my notes at home.  It was so weird!  I've never done that.  And yet, I couldn't shake the feeling that I was ready.  I had, somewhere in my deep psyche, convinced myself that no matter how much I had prepared, I wasn't ready.  I would never be ready.  I had made a mistake, somehow, enjoying myself.  And I got out of my friend's car at about 10PM, walked up the stairs to my apartment, went to brush my teeth, and something about the toothpaste or my reflection or seeing that it was close to the next day just made it all go downhill from there.

It was so weird.  One second I'm totally fine, face made up and hair flat ironed and I'm relaxed (buzzed?  Pie-coma? Confident?) and then I'm just a mess, sobbing into the bathroom sink.  Like, a scary sobbing.  The kind where if someone walked in, maybe they would have thought a family member just passed or that they cancelled the Blacklist or I received news about malignant melanoma.  But that wasn't it.  I just started crying like a 14 year old broken-hearted girl, and I couldn't stop.

Internal Monologue Veronica said "get a hold of yourself, woman.  What is your problem.  Crying just makes your eyes puffy.  Stop feeling sorry for yourself.  Relax." So maybe 30 minutes go by and with some textual coaching from Mike, everything wraps up nicely.  I can breathe.

So why did that happen?  What snapped?  This was crazy.  That was crazy, irrational behavior. But I realized, or more accurately, have come to realize that perhaps the biggest problem that plagues my day to day existence is me and my lack of self-confidence.

To be "ready" for something is such an uncomfortable and foreign feeling.  I'm not trying to be flippant or employ the humble-brag here; it's true.  I have lived 90% of my post-high school academic life convincing myself that I am the underdog: the under-performing, but high-potential student with the nontraditional background who peaked in high school as summa cum laude and that was it. The starving artist, theater-major who has never taken physiology (<--- true story), about to take a test on Essentially the BODY 101 and ALL ITS PHYSIOLOGICAL PROBLEMS IN YOUR BRAIN AND ADRENALS, DUH, and here I was literally having a mental breakdown that I felt ready.

Doesn't that sound crazy?  I live under the assumption that I am never ready, that I have to maximize every conscious moment because I will never perform on par with my peers and if I do, it must be a statistical anomaly.  And it's funny because in retrospect, I reinforce that.  Someone says, "good job," when I get a B and instead of thinking "hey, thanks," I almost immediately revert to the logic of "well, I really got a C- but that extra 8 questions of lucky guesses really put me undeservedly over my expected performance."

So while I wept like a pathetic delicate flower over my sink, these were the thoughts that permeated my mind.  You can't be ready, Veronica.  You are not allowed to be ready.  If you think you are, you are disillusioned. And disillusionment leads blindly to failure.  And thus, you are failing.  And it is weird that you have not failed out of medical school yet.

I'm not trying to justify the validity of that way of thinking.  In fact, quite the opposite.  As medical students, we are already high-achieving.  Motivated, smart, intellectually curious, whatever.  We strive to be the best in many avenues (some beyond or even excluding the classroom) because it justifies why we are here.  Some 7000-8000 applicants, some 600-800 interviews, some 400 acceptances, some 5% chance of getting accepted, pending you even meet the most basic criteria, which after all, isn't really that basic.

I remember applying to medical school in post-bacc.  I sat in the library at California State University East Bay, almost ashamed to be typing into my secondary to Pacific Northwest University of the Sciences that I had a degree from UC Irvine, a school that recently ranked FIRST in the US and fifth in the world among universities less than  50 years old by Times Higher Education (shameless plug), but here I was, in a state-school post-bacc, because I obviously couldn't do justice to the prestige of the degree that preceded me.   And it was weird that this insecurity still carries over, even after 4 acceptances, multiple interviews, the rare and incredible (really, almost unbelievable), first round luck of med school applications.  It's like sometimes, I really can't believe I am still here.  That I have hung on and not been given the boot by the very institution that said "we believe in you."

This is my opinion, but I think an easy mistake to associate preparedness with a predictable outcome; more specifically, a medical student that feels ready expecting a 100% on an exam.  Self-imposed pressure aside, you can be as ready as you want to, but medical school is medical school.  It's not meant to be easy.  You can alleviate a lot of the burden of uncertainty by preparing, by studying, by practicing, but you are not in total control of the outcome, just most of it.  Being "ready" is not synonymous with "getting A's."  I don't need to go into the factors that determine test-taking success; we all know how that works by now.  But we forget to let that uncontrollable 10% be variable, we don't like to give up the control.  In a similar way, to feel prepared and simultaneously know that there was nothing more to do was so uncomfortable to me, it made me viscerally ill. 

For the record, I did just fine on Endocrine (Derm was another story, ha).  But I convinced myself I wouldn't, in spite of my hard work.  I feel that we all do that, to some degree. Some of us are more vocal about it than others, the rest of us just wear waterproof mascara.  The point is, you do what you can, as efficiently as possible, and you leave the rest to the test.  It's not meant to be easy.

I would bitch to my mom in high school about how I was always in jeopardy of losing my Varsity spot for Cross Country. "If you want to win races, Veronica, just run faster.  It's that simple.  But don't expect to win every one.  Run faster, but you can't become an Ethiopian Olympian overnight."
Obviously this statement is laden with stereotype, but you get what I'm saying.  Do your best, and if you don't like the results, try something harder, something different.  But don't freak out if you're not first.

In the meantime, I've been preparing for a couple marathons, both on foot and in my brain.  I am taking COMLEX May 29th, and USMLE shortly thereafter.  My reasons are my own, and everyone will have their own opinion as to whether or not to take both.  But ultimately, I want choices, even if it only means 5 more program options.  I've never let money get in the way of my dreams, and sometimes it meant living out of my Hyundai or not eating anything other than canned peaches and working 3 gross jobs, but I don't care.  So I'll keep you posted on when I lose my sanity (but hopefully not).

Lastly, I leave you with art I've been doing, just because :)