The only time you run out of chances...

...is when you stop taking them.

When I finished rotations 2 weeks ago, there were still a handful of things that needed to be done in order to move forward to graduation. Yesterday, one of the biggest and most nerve-wracking pieces finally fell into place. One last evaluation needs to be submitted, and at that point, I should be cleared to receive my diploma. As I've said before, it's been a pretty hellacious couple of months and to put bluntly, I've kind of gotten used to being miserable. That's pretty lame, I know.

So when yesterday rolled around and I got the good news, I didn't quite know how to react. I'd been refreshing my Inbox like a mad woman all morning with no results. So when I refreshed it again at 12:17 p.m., I did it almost absentmindedly, not expecting to see anything. I happened to be at my best friend's house, helping her pack for her summer in Geneva where she will be working for the WHO (have I mentioned that my friends are fabulous?) and all I could really do was grab the bottom of her shirt and point at the screen. The elation was almost a foreign feeling. I know it might sound trite to say so, but it's really been so long since I've felt good about myself, and I totally did the thing where I threw my clenched fist in the air and yelled "YES!"

It was such a relief, such a weight off of my shoulders. Don't get me wrong, there's still an incredibly long road ahead of me with significant hurdles to overcome, but this was a sorely needed victory in every sense of the word. It restored some semblance of confidence and faith in myself and gave me that extra push to keep going. Yesterday, I was genuinely happy with myself- for the first time in a very long time. And it was even better to have someone to share the moment with, someone who knew full well just how much this meant to me. I called my mom to tell her and while she wasn't exuberant in her words (Indian parents aren't much for the outward expression of emotions), the relief in her voice was evident. I called my favorite Resident to fill her in and being the fabulous mentor she's been all along, the first words out of her mouth were "I'm so proud of you!" I was kinda proud of me too.

Graduation is in just about a week now. While I imagine it will still be a bittersweet day, I can honestly say, that for the first time, I'm kind of looking forward to it. Because regardless of the fact that all of my plans have spectacularly imploded in my face, and even though my future is completely uncertain, I get to graduate medical school. The 3 year old me who tormented everyone in that house with her Fisher Price medical kit and announced that she was going to be a doctor is finally making good on her promise to herself. I struggled and fought and slipped, but ultimately, I earned those initials after my name. And that is something that no one will be able to deny me. Plus lets face it, this isn't just about the M.D. degree. It's going to be my way of life from now until the end. It's a game changer.

Sure, I don't have a PGY1 spot to begin on July 1st. Without a doubt that sucks, and it kills me on the inside all the time. But as much as I might be down, I'm certainly not completely out. I have the chance to try again and to keep trying until it happens. I might end up taking the scenic route to get to where I want to be, but hell, as long as I get there, that's all that matters.

Schmaltzy

Managed to hack into my old college email inbox the other day and found a bunch of forgotten emails- some funny, some serious, some painful, but all wholly entertaining and a solid reminder of the fact that no matter how badly I may feel about myself right now, I have amazing friends who will always remind me otherwise-

7/27/05
If it weren't for you, I'd have no self-esteem. I love you man. And if I weren't tired out of my !@#$% mind, I would write something about the way you make me feel special and loved, and that the thing that I love most about you, which is... well, everything, actually. I would write about how you stand out to me from the crowd because of your compassion, your sensitivity, your thoughtfulness. I would say that in a world so full of cynics and saints, you are neither, living your life quietly watching the spectacle, occassionally picking a few people who you want to support. I would say that a true measure of character is to be considered your friend, because only the best people are.

Also, unrelated, I made the mistake of discovering that all of The Maccabeats' and Penn Masala's albums are available on Spotify. It's not like I even understand Yiddish or Hindi and yet I'm wholly obsessed with, of all things, a Jewish acapella group and an Indian acapella group. I guess there are no language barriers when it comes to appreciating men who can sing!

The Maccabeats- Cover of Miracles by Matisyahu

Penn Masala- Down/Desi Girl

Bonus: Payphones by Maroon 5 + Wiz Khalifa- I've listened to this an unhealthy amount of times since yesterday

Final Straw

Disclaimer: This post is melancholic, dark, brooding, angry, defeated, and completely un-inspiring. It is NOT a feel-good post. But there are just some things I just need to get off of my proverbial chest.

I think I've been doing a fairly decent job of holding myself together these past few months, but I woke up this morning and the stark reality of the emptiness of the next year came out of nowhere and just sucker punched me in the face. And that reality is that I am graduating medical school in less than 3 weeks and I do not have a PGY-1 spot awaiting me on July 1st. And there is no guarantee that there will ever be one. Everyone tells me I should be proud- after all- I am getting that most coveted M.D. And I don't deny that that's pretty awesome. But the fact of the matter is that in the U.S., that M.D. degree is completely useless if I don't have a residency position to go on to. Yes, there are other jobs in the medical field- PAs, NPs, MAs, etc., but while an M.D. is considered a terminal degree, it does not in any way qualify you to be able to serve in any of those positions. It sucks, but it also makes sense. So now I've got this fancy degree, thousands of dollars in debt, and nothing to show for it.

I made the mistake of browsing the ERAS site this morning and though most of the information, guidelines, rules, etc. aren't completely foreign to me, the notion of having to do it all over again is overwhelming. I am so completely overwhelmed. Having to get everything in order again and running around trying to make sure things are in place...I KNOW it has to be done, but I am so weary of things not panning out. I know I haven't expounded in great detail as to what's transpired over the course of the last year, but suffice to say that it has been HELLacious. And I've obviously been doing a very good job of ignoring it and trying to look forward but today, for some reason, it all just caught up to me and smacked me over the head.

I know that nothing good ever comes easy. That you have to work your ass off to have anything worth having. That I have to get my shit together and move forward. That next year will be different and I just have to wait it out. That I'm still young, I'm only 26 and my life is no where near being over and that I can take this year out and still be okay. I can repeat every single cliche to you because I've said them to myself enough times over the past eight months. BUT I am SO sick of it. I know there are people in this world that are worse off than I am, who will never have the opportunities that I have had, but hell, that doesn't make me feel any better. The last four years have been rewarding and exhilarating and fun, but they've also been excruciatingly painful. I try not to dwell on these things because they take my focus away from where it should be, but sometimes I can't help it. I just want to be settled and know what I'm doing with my life.

I'm just so angry and bitter at myself. I hate every single day of this. I hate how many people I have disappointed and  I hate how I have completely and utterly failed myself. My motivation is at an all time low. I feel like I've hit a brick wall one too many times. But I am a masochist at heart- I refuse to give up because I've never wanted something this badly. I love medicine. I love getting to go to work and doing what I get to do. And I know I'm good at it. But I'll be damned if at this point, I'm not on my knees pleading with God to just cut me an ounce of slack. Something has GOT to give!


There's a stellar post written by Mom's TFH over at MiM, entitled "In Case You Were Wondering" that I stumbled upon recently. While our stories are different, the sentiments are the same, particularly a few excerpts that I've quoted below-

I am tired of well meaning people asking me where I will be next year. I am tired of people telling me this was meant to happen. I am jealous, painfully jealous with a pit of hurt in my insides, of my classmates who are joyfully planning their futures...Please allow me to be self indulgently angry and defeated. This is not how my life was supposed to be at this point...I know I am extremely lucky to be (mostly) healthy and able bodied, with good support, and smart enough to have made it into medical school in the first place. I know that this is not the end of the world – I very well may match next year...

I think what scares me the most is the realization that not everything will always work out okay in the end. I can't assume that I will get through everything on the first try even if I have God's grace on my side. We are not invincible, not a single one of us. Before I got to medical school, failure was never something I thought about. Okay, fine, I once got a 45 on an Organic Chem III midterm in college, but other than that, failure wasn't a concern. I haven't set super lofty ambitions for myself but at the very least, I have succeeded in doing what I wanted to do. So what scares me now is that I am very much capable of failure. And I am capable of failing again. Because just because you keep trying, it does not mean there are any guarantees of success. Karma means nothing. The universe doesn't owe me a damn thing.

I don't expect anyone to have the answers to any of this. I wouldn't know how to deal with me either. I'm not digging for reassurance or sympathy...I just needed to get this out. And rather than subjecting someone to a painful phone call, here it is. Writing. It never fails me.

Done

1. Pre-school
2. Kindergarten
3. Elementary school
4. Junior High
5. High School
6. College
7. Medical school
8. Residency

Medical school? Yeah. That happened.

On Friday, I completed 80 consecutive weeks of rotations. In that time I put roughly 20,000 odd miles on my car. I crossed many bridges a couple hundred times and spent too many hours to count stuck in traffic. Thousands of dollars in gas and tolls. Throw in a couple cases of Luna bars, crates of water bottles, a dozen or so shawarmas, bags of Hershey's nuggets, Red Bulls for desperate mornings, passion fruit iced teas while studying for Boards, and highlighters in every color of the rainbow. And I haven't had more than 3 days off in a row since 2010.

But no matter how miserable and exhausted I may have been at a certain point on a certain rotation, looking back on it now, in retrospect, I loved all of it. Clinical medicine has my heart- it makes things come alive in a way that books and videos never will. I should get a bumper sticker that says "I'd rather be on call" because I can confidently say that that statement is accurate nearly 100% of the time. I would so much rather be in the hospital than anywhere else because it's where I'm at my happiest. And I'm really fortunate to have worked with some amazing physicians that have been nothing short of inspiring (more on this in another post). Medicine and I have had a pretty rocky relationship, but I guess you can call me a masochist, because I've never loved it more. There are honestly no words to tell you how much I love what I get to to do.

It's bittersweet though. I know it's entirely my fault- but I feel a little robbed of the celebratory aspect of it all. Yesterday was a gorgeous spring day and when I walked out of the hospital for the last time, I couldn't help but crack a smile- but it wasn't a complete one. Because while I'm done with rotations, I'm not completely free. I have the weight of graduation requirements still hanging around my neck and the entire chaos of sorting things out for this upcoming year. I've always known my next step, so right now I'm feeling a little lost. A LOT lost actually. I'd like to let out a sigh of relief, but I can't. At the earliest, I have to wait until next March. Man. That's a lot of breath holding. Nonetheless, yesterday was not all gloom and doom. I did get to fly a kite with an adorable 2 year old which was more than enough to put a jumbo sized grin on my face. Little kids are fantastic about making you forget about the real world, even if it's just for a few hours.

Graduation is in exactly three weeks. I wrestled with the idea of going vs. not going because while it is a celebratory occasion, for me, it's incomplete. But I only get one graduation from medical school in my lifetime. One chance to walk across a stage and be hooded and have that Doctor of Medicine degree conferred on me. I think I owe it to myself to be there and I'm fairly certain my sentimental soul will regret it if I didn't go. It'll be awkward and bittersweet and I'll probably feel guilty and sad...but my parents and my best friends will be in that audience, and I know on some level they are proud of this milestone, however incomplete it may be. And it's not just MY big day alone. I want to see my friends receive their MDs. Because even though I'm not happy with myself right now, I'm ecstatic for them and I want to be there for them. So I'm going. I have absolutely no idea what to expect, but hell, what about the last four years has been expected? At some point I'm going to have to learn to stop fighting the currents and see where they take me. I hope you guys will stick around for the proverbial ride.

80 weeks of IDs, not one good picture!

Graduation is in exactly four weeks which is all kinds of madness. And it was exactly two years ago today that I left Grenada for good. I have a really bizarre memory for dates, and in general, useless tidbits of information that while, usually end up making me look like a thoughtful human being, just serve to occupy space in my head that should really be full of relevant medical knowledge. For example, to this day, I still don't have the seventeen bajillion different kinds of heart murmurs memorized. But when your birthday rolls around, I will distinctly be able to recall that time four and a half months ago when you mentioned that you really wanted to read The Art of War and pick that up as a part of your present. I'm basically a mess.

End pointless entry.

I'm Just A Teenage Dirtbag Baby, Like You

AMed Rotation LOLs
Note: All identifying details, names, persons, places have been changed to uphold confidentiality.
Caveat: If you're easily offended, lack a sense of humor, cannot digest somewhat crude sentiments, are squeamish when the topic of sex is brought up, or don't remember and/or can't understand what it was like to be a hormone crazed teenager, you should probably go on and check yo'self before you wreck yo'self. 

Me: When was the last time you had sex?
Pt: February 11th of this year at 4:30 p.m.
Me: Uh, wow, that's a pretty accurate timing you just gave me
Pt: Well yeah, you know, because I was sorta staring at the clock, while, uh, you know, my girl was doing her thing. Know what I mean?
Me: ::regretting I said anything at all::

Me: How old were you when you had your first period?
Pt: ::staring blankly:: My what?
Me: Your period, you know, every month, girls-
Pt: Ohhhhhhh, you mean when I bleed like a stuck pig from my down theres?
Me: Y-eahh...exactly...

Me: Okay, so do you always use condoms?
Pt: ::nodding vehemently:: Yeah Doc, all the time. You know you gotta wrap it before you tap it! Plus I can't have my thing falling off!

Me: Alright so we set you up with an appointment with the Ortho clinic last time- did you get to go?
Pt: Nah Doc, I couldn't make it.
Me: How come? Remember how we discussed the importance of keeping that appointment so that we could figure out what was going on?
Pt: It was on 420. I mean, like I thought about going, but I just couldn't you know?
Me: ::biting my lip, playing dumb:: Yeah, I see here your appointment was on April 20th, you said Fridays would work best for you right? What was wrong with the date?
Pt: Well you know, 420 is just like a universal date of...chillin. I took my girl to see that movie with Zac Efron you know?
Me: Right...

Me: So you're a junior? What school do you go to?
Pt: ::names my alma mater::
Me: No way, I went there too! But like centuries ago.
Pt: Really? Was it as full of douchebags back then as it is now?
Me: ::biting my lip, trying not to die laughing in front of my Resident::

Pseudo-Related Throwback LoL: April 2010- 5th term BSFCR, one unlucky soul got picked to take a history from of our profs who was playing the patient.
Student: Okay, are you sexually active?
Prof as Patient: Active? No. I just kinda lie there.
::Cue all 200 odd students in Taylor Hall exploding in laughter::

Have I mentioned how much I love Medicine? Seriously. Here's to working towards a better 2013. 

This Is Where It Matters Most

Fisher Price. That's who I fondly like to blame for my decision to want to become a doctor. When I was 3, I spent Christmas in the podunk lil town of Munster, IN visiting my mom's best friend. She was an OB-Gyn and that Christmas she presented me with my very first Fisher Price medical kit. And I was friggin hooked. If it's possible, I'd love to belatedly apologize to all the people who stayed in that house for the two weeks we were there, because Lord knows I turned every single one of them into my (un)willing patients over and over and over again. I obviously can't fully recall my 3 year old self's thoughts but the notion of "this is cool, I want to help people feel better!" clearly stuck with me and has continued to stick with me to this day. People look at me skeptically when I tell them this story, but I swear it's true- for 23 of the 26 years of my life I've always known I wanted to be a doctor.

Up until I actually got to medical school, I was convinced I was going to go into Pediatrics. Kids are awesome, they seemed to like me, and I was good with them so it seemed like a perfect fit. My first rotation ever, was Pediatrics. And I was stoked because I'd been looking forward to this for so friggin long. Sick kids and chances to fix them! What could be better? And yet somehow it turned out, that Peds was not totally the field for me. I can't quite put my finger on it but somehow it didn't bring me alive like I thought it would. I blame a lot of it on myself, for perhaps having expectations that were too high or unrealistic, or something else...I don't know. I enjoyed the rotation, but I didn't leave it with a feeling of "I think this is what I want to do."

The point of that long-winded prologue was to segue into the fact that I started an Adolescent Med elective on Monday. I haven't been on Peds since last May...so it's weird to be back. Having to adjust my whole frame of reference and my approach to medical management- it takes some getting used to. For instance, no one really gets baseline labs in kids if they're not sick. And then there's all this anticipatory guidance stuff- that theoretically makes sense to me in terms of stuff I'd want to relate to a teenager, but not necessarily things that are on the forefront of my mind, especially having spent the better part of the last year fully immersed in Adult medicine and loving it. So the learning curve is a little...steep? Or maybe just one that I need to get used to again. It's not a place I expected to be at this point in my training, but I guess we all need to step out of our comfort zones at some point. Anyway, adolescents are an...interesting demographic. The patients I've seen all manage to simultaneously make me feel really old and really young/naive so there's that for you. I'm trying to remember what it was like to be in their positions, but as Sumaya astutely pointed out, I started high school twelve years ago and my brain can only hold so much before stuff starts to leak out. The one thing I feel like I can be good at is being able to empathize with girls who are in the same shoes I was in in high school. I'll refrain from the gory details, but it's been a weird few days trying to relate to these kids while dredging up some not so pleasant memories for myself. Still though, all in a day's work. 

On an unrelated note, I'm super stoked that I got to go to my first Bris today. I'm glad that between all the madness of my daily life, I was able to wrangle the time to get down to Riverdale to be there for such a special occasion. Babies man. You know they're cute and awesome and all that good stuff, but I don't think you ever really realize how amazing they are until you can step back and see how much joy they bring to their parents and family. It really is some kinda wonderful. That memory made me smile all day- while hunting for parking at work, dealing with cranky/drama-queen teenagers, and even as I was sitting in the rain and traffic with a raging migraine on what turned out to be a 1 hour and 40 minute drive home. What it boils down to is the fact that every day I'm truly grateful for all the people in my life that allow me be a part of theirs. :)