On patience & USMLE step 1 as an img/fmg

Ever felt stuck?

Had an image of how you envisioned your life to be but it just didn’t pan out or required way more sacrifice and effort than you ever imagined? 

Welcome. 

I think this is the thought process that every doctor or anyone who has very big dreams that didn’t align with their lives, whatever it may be. I can only speak from my own experience for now. My greatest achievement thus far without a doubt has to be my medical degree. No amount of money, traveling or material items can ever parallel that. 

The reason is pretty simple. It was one of the hardest things I ever had to do. It took me a lot of time and experience to realize that my mental plans and God’s plans are not always the same. I fought to convince people I could do it, fought to get into medical school, fought to finish it in the 5 years. 

You know that quote, “Everybody is a genius. But if you judge a fish by its ability to climb a tree, it will live its whole life believing that it is stupid”? I feel like that fish sometimes. Except this fish wants to climb. And that tree is medicine. And my slippery scales are represented by life.

A fish whose heart is drawn to art, languages, drama, literature and travel yet still was more curious about the human body.

Here I am again. Trying to climb higher. 

Maybe I’m just a walking contradiction but I won’t lie. I do love medicine. I’m obsessed. Modern medicine is enchanting and captivating. I may have loved art and drama and French but I devoured my biology text books like novels. 

The truth is maybe part of me just wants to do it all. I always feel there’s not enough time in the world to do all the things and experience life at its fullest. Hey, I never said I regretted anything did I? Is it so wrong to want to swim and climb? That’s the basis of evolution isn’t it? 

I always knew I wanted to become a doctor one day. My grandfather basically prophesied this  before I was even two years old. I wrote pretend prescriptions. Played with toy stethoscopes. I told my sister when I was eleven while walking through a hospital where our mother was admitted, that I would work there one day. 

I love the idea of childish innocence. I’ve always had the notion I could do anything. When my grandfather passed away later that year, I insisted that I see his body in the freezer of the morgue myself just to make sure. They pulled him out of a drawer and I couldn't be more intrigued. I grew curiouser and curiouser. 

After I graduated, I really enjoyed my medical practice. I learnt so much more and met so many wonderful doctors, nurses, families and patients who have made impressions on my heart. Made some really special human connections and seen some larger than life strength exhibited. I do value giving back. I love, love my career. Nurturing and helping people to come back to themselves is also part of my core. Medicine is full of excitement and passion and I honestly cannot see myself doing anything else with my life. But sometimes, its so hard. You really have to want it.

I after a year in general surgery and another in plastic surgery I decided that although I love my career, that particular department was eating away at my life, eventually it stopped bringing me any sort of real joy and at times I wondered when I would make up my mind to actually take the steps to start an international residency and pick a specialty to give me that life satisfaction I craved. 

It took me months of internal conflict and it started affecting my performance at work as I simply felt stagnant. I actually did about 5 pieces of art in that time and inhaled multiple novels. But art isn’t my career nor is being a bibliophile. It is my therapy.

I yearned to start something that would lead me to a life of making a real difference. One thing I knew for sure, my aim in the long run is to decrease patient hospital time and post operative complications, so I would prefer to head in a direction of minimally invasive medicine.

So I left the job altogether and signed up for my USMLE Steps. People do it all the time. How hard could it be? I've already been through medical school and started practicing. I’ll just take a few months, study, study, study and finish all the steps by December then apply for a match. No big deal. 

That was 8 months ago and I might have been slightly jaded.

Give me a painting or drawing to do. I can have it done in 3 hours. Give me a novel, done in an afternoon. I’ve directed school plays in university, acted in them, learnt entire cities in a day. But the challenge of medicine? Well. That takes some gut. For me, at least.

Now I’m no way discounting the arts. I’m just aware that it comes a little easier to me. I’ve met doctors who can rattle off book knowledge but cannot draw a diagram or recognize the most famous of Shakespearean quotes or Van Gogh piece. Come on man, everyone should know Starry Night. These people don’t impress me. 

I’m not saying I'm incapable of achieving my goal either. It's basically this- if I expected this to be Pacman, it was Final Fantasy 15. That’s the new one right? With 45 mins of just walking in the beginning of the game? The one where you have to beat the whole game before you meet the actual villain to defeat.

Just so you know, people don’t often talk about this part in online forums. As an IMG (international medical graduate) you are a foreigner, an alien. The stakes are higher, the odds are all against you and the investment, both financial and time are greater.

Since then I’ve gone through a roller coaster of highs and lows, from feeling I can do anything to sense of perpetual uselessness and incompetence. I spent sometime observing in Harvard at the Brigham and Women’s hospital. My dream hospital. And it was extraordinary. I had some amazing experiences. After meeting the director of the Advanced Multimodal  Image Guided Operating theater, she invited me to stay at her home for the rest of my time. Its one of the best things that have ever happened to me. Imagine little old me, invited by a very important person a Harvard hospital, opening up her home and family to me after meeting me for fifteen minutes? Unbelievable. I saw groundbreaking trials and new procedures. I met the authors of the textbooks I was reading.

What it did was increase the fire in me to do better. It increased the expectations of myself. Which unfortunately are limited as I am a mere human without any sort of prodigal intelligence, way too many emotions and fear of math. 

Why else would I cancel the first exam twice the night before the exam? Okay fine. Three times.

It was three. 

Today should have been my exam. 

Am I being avoidant? I don’t know. I hope subconsciously that's not the case. I do know this-  I have grown and learnt so much in the past eight months. I know I’m almost there but not quite. I enjoy the learning, I feel like a better doctor most days. Other days I see my previous colleagues moving on with their careers and lives and actually enjoying it (I’m just assuming based on social media ramblings, which is why I left social media) and become resentful of myself.

I’ve studied, stressed, cried myself to sleep, picked myself up and trudged on more times than I hoped for. Wondered if I’m some sort of masochist with a sick twisted tendency to sabotage myself while I surfed through those USMLE forums of students years younger than me who are scoring my dream scores on practice exams and bitching about how scared they are. Give me a break.

I try to look past my surfeit feelings of self loathing, depreciation and disappointment that I’m not better at learning off drug mechanisms or molecular and genetic biology or smarter, bitter that my home country didn’t offer the types of opportunities that interested me. That I wasn’t trained to write these integrative board exams. It made the system at home appear almost like satire. Am I even a real doctor? The thought of settling into surgical or radiology residency at home just does not excite me. I was bored there. Bored and frustrated with the system and just over the lack of progress and large egos of the those leading said system who are so settled in their ways and resistant to change. 

The thing about having high ambitions for yourself is that you never want to settle. So the minute I feel like I’m wasting my time, I generally say farewell. This counts for most things in my life and I often wonder if I’m a commitment phobic nomad. I try to stay on the notion that sometimes my dreams are just bigger than I am and I would have it no other way. But this time its different, I’m genuinely driven and committed. Just like a decade ago when I pushed myself to get into med school.

So I do. I do come down hard on myself for things I cannot control. Thankfully, I have been very lucky and blessed with the best family and inner circle of constant support, love and motivation. I wish I could see myself the way the people who love me do, who have unrelenting faith, who are convinced I can achieve my dreams when I cannot see the light in the dark, who understand when its overwhelming, who can see me through my disappointments and self inflicted “failures".

This type of mental pressure gets to you and clearly messes with your mind as you may conclude. I am actually weary, frustrated and ready to move forward but I just cannot settle for mediocrity. I have to be patient with myself and allow myself the chance to climb but it a timely fashion. I need to know I’ve done my absolute best and that’s what I will continue to do and promise to be kinder to myself like everyone else has been so far. 

This is your last chance, I’ll say and try not to slip. Even If I do, I will assuage myself and still climb on. I just don’t see any other way at this time.

Despite the fact that I’m actually longing to read a novel and paint a bit.

Maybe I’m just a sucker for pain.