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.