It’s The End of An Era, It’s True

This may be the end.

Of the blog, that is. Sorry if the title and lead-in were melodramatic. You see, it was just brought to my attention today that I’ve been found out. I was too cavalier with my details, and one of my classmates who read it figured out who I was in real life. After my most recent post – since deleted – she finally contacted me and (rightly) gave me a tongue lashing for posting the very private details of someone’s marital problems on the internet.

And that gave me some serious pause.

I’ve used this blog over the past year and a half as a way of internalizing and dealing with the stuff I’ve had to see and do while going through this whole medicine thing. It’s been tremendous for my mental health to be able to write about all of my experiences, and for the ability to – thanks to everyone who read and responded – feel like I wasn’t so isolated in my experiences. It’s also allowed me to touch base, and in some cases meet, some pretty excellent people.

But the reason it’s been so helpful is because it’s real. It’s my unfiltered experiences, 100% accurate, as they happen. It works because its a true catharsis, not something dressed up like how I would tell my parents. It’s somewhere I could really talk about everything – EVERYTHING – and not worry about the consequences.

But I never considered the consequences to others. I didn’t stop to think what would happen if I was ever found out. If people suddenly saw themselves in these stories. I’ve been treating it like a diary, but it’s really more of a large billboard, advertising everything – and I mean everything – that’s happened to me over the course of the last few years. And is that fair to everyone else? Sure, I’m okay with revealing my secrets and insecurities, but does that mean everyone else should. If this classmate can figure it out, then who’s to say others haven’t? That I haven’t already betrayed the trust of a friend, or a classmate or a patient?

I can’t say that. And it bothers me.

I think this blog, as it is, has to end. I can’t reconcile being truthful with being respectful, at least in this medium. It comes down to integrity – the true measure of character is how someone treats their peers in absence; betraying their trust like this is an unforgivable offense. But coupled with that is the knowledge of how tedious this blog would become for me (and maybe the readers) if I had to self-censor to the degree decorum demands. Even this post feels guarded, knowing that people who know me will be reading this.

I’m not sure what happens next. I might keep writing on my own, like a journal, or I might start trying to find another creative outlet. Thank you to everyone who’s read, written or otherwise interacted with the blog over its very short life. Believe me when I say the support made this blog a more than worthwhile endeavour.

I’m never good with closing words, so instead I’ll just drift off quietly, and try not to make a big fuss.

If you’re afraid of what you need
If you’re afraid of what you need
Look around you, you’re surrounded
It won’t get any better.
- LCD Soundsystem, “Home”

As always, I remain,

Not House

Tevye, Eat Your Heart Out

Apologies for the absence.

(It seems like I’m starting every post with that greeting).

Anyway, I’ve been away from the blog for a little while – I thought it was a good idea to get out of my head for a bit and just focus on myself. The weekend was mostly fraught with scrambling to write personal letters and badger old referees to tweak their personal letters slightly to accomodate my now rapidly diversifying residency application pool. It was actually surprisingly easy – once you’ve written one letter to a family medicine program, it’s just a matter of switching the name of one remote Canadian city for another (with apologies to any readers who may be from said locations).

I’m still not sure where I’m going to decide to focus my attentions. On the one hand, an argument could be made for concentrating my application on family medicine programs, as I figure that’s where I have the best chance of matching to. There are a few somewhat appealing options around the country, and I figure this will give me a little more mobility – I’ll be done in two years, and can set up my shingle wherever is more convenient for me and Not McBeal (with the added bonus of giving her a little more professional flexibility; family doctors are needed everywhere, so its not like I’d have trouble finding a job). No, this isn’t exactly what I had planned for my life (and there’s a spiteful part of me that believes I’m just buying into the federal government’s not-so-secret plan to generate family doctors) but it’s likely my best chance for matching in the second round.

On the other hand…

It would also essentially shutting the door on my dreams of anaesthesia. You see, it’s much harder to transfer from a two year program (such as family) to a five year one (like anaesthesia). You only get enough funding for however many years of residency you’re originally signed up for, so transferring to a longer program requires you to somehow procure the difference in funding (usually through a resident who switches in the other direction – that is, a resident who goes from a longer to shorter specialty). Family medicine residents HAVE switched in the past (I know of one such resident this year who went from family medicine at my school to radiology in another school), but its certainly difficult. Applying to a bunch of five year specialties would at least give me a fighting chance to transfer into an anaesthesia program of my choice.

On the other hand…

Have you seen what’s left? Aside from a few very choice spots (which I’m sure everyone and their sister will be gunning for – remember, the second round is not only for people who didn’t match this year, but also for all the international students who didn’t match, as well as first year residents looking to transfer out of their programs) the pickings are rather slim: pathology (boring) radiation oncology (boring, but with lazers) psychiatry (have you READ the last three weeks of my blog?) and public health (all the work of doing a masters in clinical epidemiology with none of the…degree). If I’m not able to transfer, then I’m stuck in a program that I would be even MORE miserable in.

On the other hand…

Who says I even want to apply to another anaesthesia program, even if I get one of those five year programs? I’ve been giving this one a lot of thought. Yes, every year has its fluctuations and variances, and yes the process is an imperfect science, but what I keep coming back to is this – if a program wanted me enough, I’d be there. It’s not like I only ranked a few programs, or restricted my applications to one region. Why should I push, fight and struggle for a program that didn’t care enough for me in the first place? Why should I make the effort, when I’ve already sunken a significant amount of money and time into said effort, only to come up empty?

On the other hand…

If I really want this enough, shouldn’t I keep fighting for it? Not take this lying down, but keep on trying until I get it?

Ugh.

At least I don’t have any daughters.

Unfortunately, being a physician IS a tradition in my people.

So, now what?

I’d first like to take a moment to thank everyone out there for their support and kind wishes. It’s one thing to have your classmates and friends – people who see you everyday – wish you well, but to have complete strangers offer such kind and sincere consolidations….well, it’s really touching.

(I hope my tone is coming through; I’m not trying to be sarcastic).

I’m not gonna lie, yesterday was pretty rough. I briefly contemplated showing up at the match day party that our school was holding, but then realized this would be an utterly horrid idea. Not McBeal, in a completely shocking move, managed to make the trek down here just for the day and managed to do a pretty good job of distracting me with burritos, movies and cuddling. I didn’t manage to get much sleep, because I was absolutely dreading going into work today.

Obsessively (I admit) I had been checking Facebook and my text messages and figured out where everyone had matched, so I had a pretty good sense of the lay of the land. Overall, my school was decimated – I had heard upwards of 25 people not matching, including two other people who applied to anaesthesia, which made me feel a little better (for about 10 minutes….misery loves company after all). In fact, I later found out we matched more students to opthalmology (typically one of, if not the, most competitive specialties) than anaesthesia. There were actually four of us in total in my clerkship rotation that didn’t match in total. It was with a bit of pride I noted I was the only one who had managed to go to clinic today – the rest were (understandably) away. But like I’ve said before, this is what you have to do in medicine, even at the trainee level. You have to put your personal issues on the side, leave them at the hospital door, no matter how awful and wretched they may make you feel.

Surprisingly, most people had enough tact not to press the issue too much. Many of my classmates had already heard (bad news travels fast in med school) and offered their condolences, even some of my classmates who had managed to match in anaesthesia which I quickly put a stop to. If I wanted to dwell on it, I would still be holed up in my room, alternating between a tub of Ben and Jerry’s and a bottle of Jack Daniels, watching “Never Been Kissed”, and blasting Dashboard Confessional or Good Charlotte. Of course, that didn’t stop most people from greeting me with that same elongated “heeeeeeeeeeeeeeey Not House” I’ve come to see from families visiting their sick relatives.

Now, one of my classmates, meaning well, kept trying to reassure me how strong I was for coming in today, and how much personal courage it took. An appreciated sentiment, but I didn’t need her to tell me how “brave” and “courageous” I was – all that did was highlight exactly what a pariah I am to the rest of my classmates, like a delicate porcelain doll that you have to handle with care or else risk shattering (emotionally) into a bunch of pieces.

The day has been going pretty well so far (I’m on my lunch break right now) – I’m trying to keep busy so as to not dwell on it, but its hard when I keep getting distracted by 1) sympathy emails and texts from friends and family, including my parents who are coming in for dinner tonight and which I am utterly dreading and 2) business emails, reminding me about the administrative things I need to take care of in order to get ready for the second round. Between reading transcripts again, sending out frantic appeals for letters of reference and trying to figure out whether it is worth it to study family medicine in Reindeer Groin, Alberta, it’s a very frantic time.

And frantic is not what I need right now.

I guess the hardest part is really how disruptive this is to my little idyllic picture as to how the next few months was going to play out. I was going to match somewhere, coast through the last few weeks of rotation, study hard for my LMCC (qualifying exam), go vacation somewhere in Europe and then come back ready to face the challenges of residency. Instead, I spend the next two months agonizing over a SECOND round of this bullshit (the second round match isn’t until late April), worrying how I will feel if I fail a second time, and generally having to put my life on hold until then. Oh, except for the LMCC; I still have to write that. Now how motivated do you think I feel about writing a big final test to certify me to practice medicine as a resident when I’m not even sure I’ll BE a resident next year.

I guess its just hard listening to classmates prepare for their moves, their vacations, their futures, when your future is so unsure.

But, like I said, the guest list at the pity party is all full, so I think I’m just going to crash the “pull yourself up and get your shit together” party down the road.

(Okay, that was an awful metaphor, but you get the idea).

I called it heads…

"We regret to inform you that you have not been matched"

It’s kind of hard trying articulate exactly what I’m feeling right now. It’s even harder when my thoughts keep getting interrupted by text messages, emails and calls from friends and family asking me how it went. Though everyone has been more than sympathetic, it’s really hard when I don’t want to talk to anyone, let alone think about this. But unfortunately, I have to. You see, the second round deadline for submitting applications is a week from now, so in this week, while I’m still reeling from the shock, I’ve got to get my thoughts together enough to try and figure out where I’m going to apply that’s still available in second round. The pickings are notoriously slim, with most of the unmatched spots in psychiatry and radiation oncology (two specialties I have no interest in), and a smattering of family medicine spots, mostly in the places where they’ve only recently discovered running water and electricity. And frankly, my mind is on anything but this, but the timeline is so short I have no choice but to push through it.

I was at least proud of myself for keeping it together while I was in the hospital. My psych supervisor told me to take the afternoon off to try and get my affairs in order, and to clear my head. The affairs, I think I can handle….the head clearing not so much.

This wasn’t how it was supposed to happen. You don’t spend years studying, working, aching, pushing, sacrificing for this. You spend it to get to that light at the end of the tunnel, to get that reward for everything you’ve done. Three weeks around the country, thousands of dollars on suits, flights, hotels, meals and drinks, all down the drain. Not McBeal, angel that she is, is offering to trek down here tonight (despite the substantial distance and impact on her time).  Part of me just wants to tear into that bottle of whiskey on the counter I got as a gift from her in anticipation of a celebration, but the better half of me knows I’d only rebound worse the next day.

I’m trying to be happy for my classmates – this wasn’t their fault, and they all deserve the success they got. But I’m really not sure how I’m going to face them tomorrow in clinic. I’m sure they’ll be all sympathy and smiles, but they can’t know what I’m feeling right now. Just an emptiness, a hallowness, that just seems to reconfirm all the years of doubt, guilt and regret that I’ve spent in this place.

I wasn’t good enough.

Am I good enough?

I don’t know.

Self pity doesn’t fill out the applications, though, so I’ve got to get back to that.

And spending the morning talking to borderline teens probably wasn’t the best framing device for today.

Here It Is.

Waiting time is over.

It’s funny, normally I try to write these posts the night before (as evidenced by the disjointed timelines) but today I knew that nothing could properly capture the combination of fear, dread and excitement that I’m feeling right now. There are no more sleeps, there are no more chances – it all comes down to one email that I’ll get at twelve noon. One email that changes my life for the next five years.

I don’t really have anything profound to say here – my normal verbal excess is failing me here – so all I can say is that 12 oclock can’t come fast enough.

Wish me luck.

Folie A Deux

Two. More. Days.

This weekend has been especially hard to try and keep busy. There’s only so much psychiatry you can read about before you start blending schizoid, schizotypal, schizophreniform, schizoaffective and schizophrenic all together in your head (and, for the record, psychiatry uses way too many “schizo-” prefixes, in the same way neurosurgery uses too many “spondyl-” prefixes). The gym can only take up an hour of your time each day (at least for me; I’m sure some of my more prodigious classmates could spend several hours there and not get bored). And socializing, while nice to see my classmates, is also never really that productive, because inevitably, we simply return back to the topic of CaRMS.

The best/worst part of it all is the rumours that keep getting spread in this frenzy of mass hysteria. Most of them are spread by people who are worried about their own odds (yours truly included in that number), and though initially compelling, most of them fail to stand up to much scrutiny:

School X makes sure no students go unmatched by forcing their residency programs to take students who went unmatched.

Leaving aside for the moment the fact that I have heard this rumour applied to three different schools, it seems ridiculous to think that a program director of any residency program would actually do that. Why would they accept someone in their program someone who, you know, wasn’t good enough for them in the first place, just because the dean of medicine wants his/her school to look good? After all, a program director’s first loyalty is to their program, and I doubt they’d be very keen on taking in other students who didn’t make the cut initially. And furthermore, what if the students in question didn’t rank their home school, or would be very unhappy matching to their home school? Clearly untrue.

Specialty X had so many more applicants than last year; so many more people are going to go unmatched.

This is a classic example of how hard it is for us to see the forest from the trees. Of course, while on tour, all we were exposed to were the myriad people applying for our specialty of choice. After spending so much time with them, no matter what the true number of people is, your cohort seems to be innumerable, and you start getting worried about how many people you’ve seen on tour. This is a cognitive trick that we play on ourselves, however, because we don’t really know the true number of applicants overall or to any individual school (unless, like one school, you sent an email to every applicant who got an interview and forgot to BCC it). We see many different faces at each stop, and so assume all of these people have applied to all the schools, forgetting the fact some people will only apply to a few schools or only in a certain region. The result is an overinflation (in our heads) of how many people applied. Realistically, the number of applicants for each specialty stays *ROUGHLY* the same year to year (and I say roughly; there are certainly trends in one direction or another over the past few years, and smaller programs will be more likely to suffer from random fluctuations), so you have a decent idea of how many people are applying and what the odds are.

Your medical school knows what program you’ve matched to the week/month/year/since the Earth cooled before Match Day and will contact you the week before to help you with the second round and/or future career planning. 

This is one of those rumours that has a grain of truth to it. This rumour is usually accompanied by the explanation that this system was put in place because one student in years past committed suicide after not matching (which, if true, is horrible). In years past, CaRMS used to contact those who didn’t match a few days earlier, just to give them more time to apply to the second round, so this certainly sounds plausible, and had the result of lulling me into a false sense of security this past week, as I received no communiques from my administration. Of course, with my Type-A classmates, rumours were never good enough, so several of them wrote to the student affairs co-ordinator who confirmed the school received the notification about who didn’t match at the same time we did. That, I will admit, is a bit of a disappointment.

I think the real reason I started writing down these rumours is to reassure myself they are not true. It’s very easy to get swept up in the mass hysteria of this time of year. Tensions are higher than they’ve been in years, and so much is riding on one little email. I’ve actually surprised myself in that I haven’t been swept up in full-blown panic attacks yet, only feeling twinges of anxiety and stress every so often. I’m sure that will all change Monday night/Tuesday morning, though.

Then we’ll really see how delusional I was.

If Your Mother Only Knew

We interviewed a new patient today – a young guy who was picked up outside our doors literally collapsed in the street. This has always been the scariest rotation for me, since the age of onset some of the worst disorders – mania and schizophrenia specifically – is exactly my age. It just as easily could be me sitting in one of those chairs. I’ve been counting my blessings that, in this regard, I’m in the 99%.

Anyway, he spend the better part of an hour rambling in his disjointed way all about what he’d been up to. Apparently, he was “lost in himself” and had no idea where he’d been the past few days. I can’t hope to recapture how all over the place he was – somewhere between tangental and circumstantial with a good smattering of loosening of associations. In essence, he endorsed hearing voices telling him to hurt himself and his brother (who he lived with), and felt we were projecting emotions onto him. He was surprisingly insightful to this – usually people with thoughts like this are very adamant they are correct, and no amount of convincing can sway them otherwise.

He would also periodically turn to me or the nurse in the room and tell us what our “actions were telling on to him [sic]” – the nurse’s actions were usually interpreted as benign, while mine were usually making him not answer questions (for example, he said that because I crossed my legs, he couldn’t tell us where he grew up). Finally, after a lot of redirections and clarifications, we finished the interview, and asked him if he had anything to add or say.

Normally constantly figeting and squirming in his seat, he suddenly bolted still and looked at us with great intensity in his eyes.

“Yes.”

“What would you like to say?” asked my supervisor.

“I feel I really need to do this right now. May I beatbox?”

There was a moment of silence, while my supervisor, one of the more senior members of the psych department looked at him in puzzlement. Fortunately, the nurse immediately cued in on the fact my boss had absolutely no freaking idea what beatboxing was, and so leaned in and quickly explained.

“Oh. Okay, yes of course”

He leaned forward and squeezed his face in concentration.

“I’m going to do Rahzel. Do you know Rahzel”

“Yes” I interjected. “I do”. (Yes, I did; even this upper-middle class Jewish medical student has a bit of hip-hop in him.)

“Okay, I’m going to do ‘If Your Mother Only Knew‘, but do the beat at the same time as the words”

“Cool”

And without any further adieu, he proceeded to lean forward and flawlessly render that song. After finishing the last notes, I told him with (genuine) amazement his rendition was pretty damn good.

He looked like a kid who had just got his favorite toy for Christmas. Wordlessly, he stood up and happily waltzed out of the room with the nurse, a far cry from his unenthusiastic shuffle that had brought him in.

Therapeutic Beatboxing…I think it has some potential.