exams

A post for anyone sitting any exam in medicine.

I have a dear friend sitting a fellowship exam in a few months.  Said friend is brilliant – we’ve known each other since first year of medical school, and when she’s passed this exam, she’s qualified to be far richer than me.  Her specialty is so safety-critical (there are varying degrees of this depending on what field you choose), that it has an exam when you start training, and an exit-exam at the end.  And like all medical exams, they’re a curious mix of vague multiple choice exams, essay questions on things you know nothing about that you’ve never heard of in your day-to-day job, and face-to-face arrangements where you either stand in front of a bunch of serious looking guys who are all much bigger than you, answering questions on scientific obscurity, or, getting 6 minutes (in front of same bunch of guys), to examine someone and confidently make a diagnosis, usually obscure.  FUN right!

The BEST part, is that there is no real curriculum.  It’s not like university where, for the most part, if you show up to lectures and do your readings you’ll do alright, and if you’re really interested you’ll get HDs.  Or you do the easily-available past papers and your lecturers write questions based on the semester material.  There’s ‘the curriculum’ they provide you, which is really just a list of all medicine. (Hot tip; there are now over 7000 drugs you can prescribe, let alone all the diseases, genetic mutations, crazy new drugs, diagnostic procedures – I could go on!).  There’s also the part of you (especially when you’re a woman, occasionally one of your examiners might be a woman but that’s it), that just isn’t used to the idea of being a specialist doctor.  You think, ‘who, me?’  because ten minutes ago you were playing beer pong in a seedy bar in medical school thinking you were the coolest ever because you’d never been cool until that moment you played beer pong.  But specialists don’t play beer pong, they wear suits and have serious faces and Know Everything.  Their juniors are scared of them and scramble at the slightest hint they’re coming to make sure everything is ready and beat themselves up for a good week if they haven’t gotten to something, longer if the specialist gives them grief about it.  And you’re a junior for so long you don’t know what it is to be a boss.  Does anyone?

One minute you’re in medical school playing beer pong even though you don’t like beer, thinking you’re the coolest ever, hiding up the back of the lecture theatre with your friend hoping no one asks you a question while your friend does the crossword, or standing in the path lab being told about the special tubes in some machine when really you just want a nap – and suddenly you’re sitting fellowship exams?  About to become a boss??  Really?

And yet, here you are my friend.  Yes you, about to become a boss.  And here I am bursting with pride, watching you jump into that black hole of study.

Studying for these exams is like being blindfolded and tied up and straightjacketed and asked to swim in a straight line across a lake.  Nothing you do is every enough.  Everyone is better than you.  Everyone studies better than you, and magically is going to do better than you.  It is mandatory that you beat yourself up for not understanding statistical theory they offer whole degrees in.  If you’re a guy, you grow a long beard and it’s not movember, out of some strange time-marking ritual.  You can’t speak to anyone.  You don’t want to do anything but study but you can’t study because you’re exhausted from your 12 hour shifts that usually go much longer if you’re a caring doctor.  You walk outside and the light blinds your eyes and you see regular people doing regular things and they feel like aliens.  You do really badly on your practice exams.  So badly sometimes, you can’t even talk about it because if anyone found out The Truth, they would know that you don’t deserve this.  You don’t deserve to be a boss, what are you doing here?  You get 35% on a practice exam, how dare you even dream of it?  Most people would give up, surely?

Except you do deserve it.  And here you are.  Dressing up and showing up, in one way or another, at that study desk days in and days out.  Doing good some days, badly on others, not enough on some, too much on others.  Trying to find that balance that can’t be found.  Falling down that rabbit hole that has to be gone down for success.  Entertaining the idea, that subversive, dangerous idea that maybe you can.  Maybe, just maybe, all that learning and forgetting and learning and forgetting, and failing and succeeding is just exactly what you need.  On the day you’re going to see that question you failed a thousand times over and you’re going to remember the answer.  On the day you walk into that room and there are 5 guys in suits, maybe a token woman, you’re going to remember every single guy in a suit who gave you grief over the last 6 years and know that they can’t hurt you.

And because you’ve passed all of your exams with high marks so beautifully before (or maybe you didn’t but regardless, you still got here), you’ll know that you can do this because you’ve done it before.  You know that all those study sessions, the long ones, the short ones, the failed ones, the successful ones are all just coins in a bucket and you’ve filled the bucket up a thousand times over.  On the day, you’re going to walk in there and everything will just kick in, you wont be you anymore, you wont have control over what you say because your training will take over and the fancy, suit wearing specialist will take over and choose the best answers for their patient.  The safe answers, the caring answer, the non-experimental answers, the ethical answers.  And even if the roof caves in and the exam is cancelled you know you’re going to be okay and that the sun will keep rising whether you want it to or not, and all of your friends and family will be cheering on the other side, roof or no roof.

All of this is a process of shedding your skin and growing a new one.  It takes time, and it’s painful and it doesn’t necessarily go smoothly.

Here’s the best part though.  You’re not going to be that specialist.  You’re not going to be the one in the suit with the five other serious looking ones who gave you grief when you were an intern.  You’re going to be the one with the kind smile.  With the twinkle in their eye.  Who tells their intern not to sweat it if they didn’t follow up on something non-critical within 3 hours of being asked to do it.  You’re going to be the new breed, the next generation of specialist.  The dynamic, friendly and brilliant kind who are currently just sprinkled about like little oases of relief in a world of so much stress and anxiety.  That’s who you’re becoming right now.  Try it on.  You’ll probably find that it fits better than you ever imagined.

No matter where you are in medicine – first year, or pre-fellowship, this post is for you.  All the very best of luck.

Delayed gratification.

After you pass your specialty exams and that initial “I’m so elated I can literally not feel pain or heat or cold or anything other than epic joy” feeling wears off, you inevitably go through the stages of post-examhood.  There’s the part where you promise yourself you’re always going to have this amazing level of knowledge and spout facts to anyone who’ll listen – your boss, your intern, the ward clerk, the nice coffee lady and sometimes the endlessly giving patient fridge.  Then there’s the part where you make up for all the time lost not-exercising, so you sign up to a gym and start working out maniacally as if there’s some way you can cram all that lost time into a week.  Then you overhaul your hair, your makeup, start wearing nice dresses and heels to work to prove to everyone you were only just a thrown-together massive slob while you were going through exams.  You stuff your fridge full of healthy stuff and start banging on about how much energy you have now that you exercise and eat well and brush your hair…

And then you crash.  You crash so hard you can barely drag yourself to work, your clothes look like you’ve been travelling for weeks, and your hair, it just can’t be spoken about.  That awesome amazing flawless human that you became for oh, about a week evaporates and you start lurking in the corners, hoping no one will notice how terrible you look and feel only you don’t know why because you should be feeling great right?  You’re through!  Through all the exams forever!  So you keep schlepping to work hoping that whatever this is, hormones?, not enough food? wears off only it doesn’t.  It doesn’t because for two years you haven’t stopped.  Exams are over but the job where you don’t sit down and walk all day and people fight over getting to sit in a chair (actually it’s a polite “no you sit in the chair!” type of argument) and some days it’s sad story after sad story, or worse, death after death, and those 15 hour weekend shifts are still there.  They are still there and you haven’t stopped.  And suddenly you’ve called in sick, feeling horribly guilty at the scared tone in your interns voice despite all your reassurances that the bosses wont eat them if they call them, with horrible bronchitis.

And then you do what any sane rational person feeling completely out of control does.  You spend way too much money online. “Bras? I haven’t bought any how long? CLICK! Ooh Philosophy does a peppermint body wash? I need body wash!  CLICK! ” and suddenly you’re stacking coupon codes and having a big box of Benefit products with more free samples than there is product coming your way.  Then you go and do all these pop psychology quizzes about what makes you feel out of control and then you think that if you just ate better then you wouldn’t get sick so much, so back onto overhauling your diet it is and suddenly your grocery cart is full of raw cacao, which as far as I can tell is a higher calorie version of cocoa, chia seeds, and Medjool dates because in some way, these must be superior since all the raw/Paleo/wholefoods people use them in everything.

No matter how many times you sit an exam in medicine, this happens every single time.  You cannot prepare for it, and you forget about it every single time.  The worst or best part, I can’t tell, is that it feels great.  And then you crash from that and get your credit card bill.  Mainly it’s that the whole wide world, that you’ve been denying yourself for two years is suddenly wide open and you want it all.  Now.  And at once.  This is probably why doctors wind up in the media doing stupid stuff sometimes.  That juggernaut of delayed gratification gets us in the end.

Dust, the regular kind.

I sat down tonight, hair wet from the shower I had time to have, after playing with my baby all evening.  I realised that it’s been a month exactly since I posted, and it’s probably taken that long to start feeling like me again.  The person I was before medicine deconstructed me.  The dust is finally settling, and here I am, nearly 8 years on from starting medical schools, with all exams finally, finally behind me.  I can be who I want and learn what I want when I want.  In the past few weeks I baked a birthday cake for my one year old, I sewed a ton of quilt blocks for a quilt for her, I hung out with friends, drunk champagne, read books, did a yoga course – all things normal people do.  I still go to work and see terrible things from time to time, but it’s different now.  I get to have hobbies again.

And at work I’m clearheaded than I’ve ever been.  I see the problems, I investigate the problems, and I have plans for the problems.  I’m not perfect but that loud voice of self-doubt has evaporated and been replaced with a ‘you passed the Royal Australian College of Physicians exams!” voice whenever self doubt appears.  I will say this about education – once you’ve got it, no one can take it from you.  No matter what happens in life, it will always be yours, no matter what you choose to learn.

My blog is probably going to get less personal and more fun from hereon, but I’m so looking forward to the little things.

Stardust.

3 months.  3 months I saw patients with varying degrees of attention and quality.  3 months I walked those corridors, struggled through them, cried in them.  I cried every. single. day.  In cupboards, to my friends, and into my lunch.  I left evening teaching early because my breasts were like rocks and leaking but I couldn’t stop breastfeeding because it’s all I felt like I had for her as a mother.  I had nothing else to give her.

3 months I froze and practiced and froze and practiced and froze and froze until I didn’t anymore.  The words started to come, not perfectly, but there they were.  A semblage of structure, something approaching sense coming out of my mouth.  I was struggling and behind right up until the last two days, two days before, it suddenly started to click.  I have lived my life to varying degrees of raw and burnt out and never before have I been so raw and burnt out.

3 months I sat in teaching, feeling like an outsider, feeling like I shouldn’t be there.  Mother’s don’t do this.  My colleagues were already in study groups, they didn’t know me nor I them and I was alone.  Mother’s on TV were doing washing and not letting their babies watch television and steaming sweet potatoes.  Mother’s don’t do this.  They don’t become mothers and sit both specialty training exams in the same year. I cried.  I can’t repeat how much I cried.

And for 3 months my husband, not without his own challenges, got the baby up and fed the baby and changed the baby and played with the baby, rinse and repeat for 12 hours a day.  That precious hour I got with her was a shadow.  I could barely look at his drawn and haggard face, the guilt nearly killed me.  3 months of the most crushing guilt and escalating burnout.

I showed up on the day, exhausted, in something resembling a suit that I’d cobbled together to fit my new odd-shaped body.  My hair has all fallen out from breastfeeding and stress and it was barely passable.  My tights felt uncomfortable.  I walked in there and did my thing.  I forgot to do so many things.  I said stupid stuff.  I ran away in the lunch break and cried some more, somehow there were still tears left.  I listened to the other candidates bang on at each other with nervous excitement.  I sat on hard plastic chairs in a 1970s hospital lunch cafeteria and ate a bad sandwich.  After lunch I did embarrassingly badly, I can hardly think about it.

Afterwards I went and sat in my hotel bar and bought myself a glass of champagne because everyone who’d sat it sent lots of messages to our group about how happy they felt that it was done.  I drank that glass and cried some more.  I didn’t feel happy.  I felt broken and defeated.  And stupid.  Really really stupid.  Only a stupid person would attempt this with a baby and no extra family support.  For the next two weeks I was so sure I’d failed.

And there it was, like stardust.

In my inbox, there it was.  For whatever reason, uncomfortable stockings, imperfect skills and hair and motherhood, I passed.  In spite of it all, I passed.

No one I worked with could ever really understand the self-doubt I felt.  From the outside I seem to have it more-or-less together except for the corridor-tears with my inner circle.  So much has happened since I started this journey in 2013.  More than I want to recount or even think about.  I’m a different person than the one who started.

The further down the rabbit-hole I go the less I feel like I know.  But I know that for what it’s worth, I did this.  I really really did this.  I got into medical school, survived it, and did the physician exams and passed them.   Whatever happened long ago, who I might have been and the things that might have happened just don’t matter anymore, because I did this.  And I can’t wait to get on with my life.

The perfect set of circumstances.

It’s December.  The sun is shining but I can’t feel it.  I live over the road from the sea but the water feels like it’s a million miles away.  My body feels a thousand years old and the baby has been asleep for no longer than an hour at a time over the last few days.  My exam notes are on the floor in a corner and I’m staring at the wall, asking my mother, through a veil of coffee-tinged fog, what craziness had entered my head that thought I could sit a five hour written examination with a newborn?  My mother shrugs and says “you can spend your whole life waiting for the perfect set of circumstances”.

And there it is, like lightning.

And here I am again, 3 weeks out from exam number 2, horribly horribly behind, with a small baby, the loving and long suffering husband, and us, just us, in our tiny place, with all our family interstate.  My colleagues put in hours and hours and I come home to see my little girl who gets a new superpower every day without me being there.  She is always happy to see me and my heart lives in various stages of broken.

I cry at work almost daily, mainly out of frustration.  Too many patients, not enough time, I don’t really know my colleagues, I have no little group.  They walk around the hospital in their study groups, diligently seeing cases.  I have no courage.  I present cases, I’m told things like “you need to work on your knowledge, your confidence, your face, your eyes, your words”.  I cry some more, and keep going.  The circumstances are far beyond ideal.  I’m incredibly close to failing.

And then I come home, to my loving and long suffering husband, to my smiling baby and my tiny apartment near the sea.  I talk to my friends via text because phonecalls in the evening are pointless with a baby and they cheer me on.  I think how lucky I am to have everything I have, exam or no exam.

have the perfect set of circumstances.  Maybe not for a huge exam, but I’ll do my best.