Step 1: Post Exam Thoughts (Part 3)

 

Sometimes I feel weird writing this stuff on here. But I pay for the domain so I guess I can write what I feel. I am not some infallible medical school prophet. I am just your medical school classmate. If you’d like to read a post of my morose complaints and reflections, continue. If not, no worries.

While this post is highly personal, I do believe there are lessons that can be extracted by all. This is simply something I’ve needed to get off my chest. My second year of medical school was the most difficult of my life. With deaths, a break-up, and pure social isolation with Step 1 looming around the corner, it was a tough year for me. I can smile now that it’s over, but it’s always important to reflect.


 

Four black roses lie in my mind’s cemetery.

  • A star college athlete with a full tuition scholarship. An infectious smile, a wit that made you jealous you weren’t as clever as him, and ultimately, a wonderful and deeply loved young man who was more depressed than any of us cared to realize. Fentanyl. 23.
  • A friend since middle school. A partner in mischief. An endless vault of memories, laughter, and good times. And under the surface, a deeply caring guy who would call this med student up just talk once or twice a month. Motor vehicle accident. 23.
  • A young guy with charm, humor and wisdom well beyond his age. A guy I shared the best weekend of my life with. He made a lasting impression on me and reminded me what it means to be alive and in the moment. Motor vehicle accident. 22.
  • A loving, brilliant woman who would light up with excitement every time I decided to call. A woman who told stories, gave advice, and simply loved hearing my voice. My grandmother. Stroke. 83.

 

Can you blame me?

From a friend to a prayer card on my refrigerator. From a man to a memory. From a loving voice at the end of the phone to an obituary. The pictures, the prayer cards, the ignored texts on my phone that I refuse to delete. The missed calls that piled up without answer, or even an explanation as to why I didn’t answer the calls.

Wouldn’t anyone become a little weird after losing four people in the span of a few months? With Step 1 looming around the corner? While living alone?

But no, I was too proud and tough to throw up a white flag and tell anyone that I was having a hard time. I didn’t even want to admit it to myself. I told myself I was fine and everything was good. Hey man, its totally normal that you haven’t left your apartment in three days! It’s completely acceptable to ignore and run from all social interaction!

It was like a cancer. It grew slowly. I didn’t have any symptoms at first. I was OK. That’s what I told everyone. Then I started to notice a collection of weird symptoms all of the sudden. It had metastasized.

My body. My mood. My personal relationships.

It hit at once. The reflection began with an explosion when my significant other, who I had been with since my final year of college, decided to completely cut me out of her life as I was entering dedicated.

I was crushed, confused, and completely lost. During my first week of dedicated, I didn’t do a single thing other than take NBME 15. Nothing else. I didn’t read First Aid. I didnt do UWorld questions. I did nothing. That first dedicated baseline practice test was a 248. I had six weeks to go. I didn’t know what to do with myself. My world had come crashing down. I sat around and moped. I stayed up until five or six in the morning and slept until noon each day. I had to force myself to eat.

I didn’t leave my apartment. I didn’t interact with any other human beings. I just sat there. Thinking. Tormenting myself. What had I done? How did we get here? Where can I go from here? Why?

I called my mom and talked to her for several hours daily. I had no one left. I had zero classmates to turn to for help. Because I had secluded myself from all of them. I hadn’t reached out to friends in months. I ignored calls and texts. And I had driven my girlfriend away. She was the only person keeping me sane during the year. I talked to her daily for the past three years. And suddenly, she was gone. It wasn’t until she left that I was truly able to realize how alone I was. At home, I have many close friends. But us guys just don’t really talk about these things. And I hadn’t seen most of them since the funerals.

So I finally admitted defeat. I reached out to my school, told them what had been going on, and asked to talk to someone. They put me in touch with a teacher at our school. Lets call him Dr. B. They said he was the man I needed to speak to. They were right. I owe him the world.

He exposed deep truths about myself that I had been too blind to see.

A friend of mine died labor day weekend. That’s when it began. I attended his services. Hugged his sobbing mother and father. Mustered a weak, “I’m sorry”. Came home and bottled it all in. Stopped going out with classmates. Embraced isolation.

The week of thanksgiving break, one of my closest friends died tragically in an automobile accident. He was the passenger. The driver walked home and left him to die. I never had a proper opportunity to grieve. He was one of my best friends. He was gone. Again, I hugged his sobbing parents. His father, a grown man, shaking and crying uncontrollably, repeated, “He loved you J. He always talked about you. He loved you so much” while wrapping me in his arms. I cannot empathize with the loss of a child. None of us can. But I absorbed their pain.

Then a week later, I had no one to talk to about it. My girlfriend didn’t care, or maybe it simply made her uncomfortable to hear about. So I never brought it up. I thought about him every day and night. I should have reached out to someone. I should have sought help. But I secluded myself in my apartment and started studying for Step 1.

From that time forward, nothing else mattered to me. Step 1 was my way of running from how I felt. I sublimated all the pain and anger and sadness into studying. It was the only way for me to block out the thoughts of death. The existential confusion. The “what ifs”. The stabbing guilt for ignoring his texts and calls, when he was one of the very few people in my life who would actually make an effort to check in on me. It haunted me.

I refused to leave. I refused to go get drinks with classmates. I stopped watching movies. I stopped playing my guitar. I didn’t do anything else. And when I wasn’t studying, I was reading about studying – on Reddit or something like that.

I stopped caring about everything I used to care about. Step 1 was all I cared about. At first, I set out with a goal score of “above average”. 235 would be great. 240+ plus would be amazing. Each month that goal score climbed. Eventually I had convinced myself that I needed to score a 260+.

I was no longer excited about the things that used to excite me. I was excited for the weekend so that I could study from the moment I woke up until I went to bed without interruption. But as Dr. B pointed out, this pressure that I had welcomed was just my way of running from my problems. And it was obviously unhealthy.

During the beginning of the spring semester, it had become crystal clear that I didn’t have any friends left at school. I’d sit in the very back of class, bolt out as soon as lecture ended, and call my girlfriend so I didn’t have to interact with anyone. I’d watch them having fun on Snapchat or Instagram while I sat at home in my apartment and studied on Friday and Saturday nights. At that point, I knew any hope of a social life, or balance, was long gone. Good, I thought. I will crush Step 1. That will make me happy.

On a Sunday in March, my girlfriend informed me that another friend had died. He was a few years younger than me. We camped together at Bonnaroo in 2015. He was one of the wittiest and funniest people I knew. He was so full of life and energy that being around him was actually inspiring. He was T-boned by a truck on a Saturday night. He was gone by Sunday.

Then my father called me and told me that my grandmother had passed away. He was always urging me to call her, to reach out, to stay in touch. I mostly ignored this. Remember, I was a busy medical student and no one else mattered. I wouldn’t make time for anyone else. I wish I had, now.

But at this point, I couldn’t cry anymore. Not a single tear. I was done. A zombie. I just convinced myself that this was all okay. I told myself I was fine. But by now, I had completely lost myself. And I just studied more.

I started telling my girlfriend that her little calls to check in with me during the day were taking up too much of my time. I had given up on working out and eating healthy. I had given up on a normal sleep routine. I didn’t want to write. I wouldn’t even let myself take a Saturday night off to watch a movie. I didn’t even want to go out and have fun anymore. I just wanted to study. Cabin fever.

I didn’t even realize I was doing it at them time. But when Dr. B explained it to me, it all made sense. I went through a traumatic time filled with loss. I didn’t grieve. I didn’t spend time with family and friends. I went back to school and built a wall around myself and ran from it. I drowned myself in studying. And by dedicated, I had driven many people away. People I cared about.

Dr. B asked me about the last day that I truly felt happy to be in our city. I thought for a moment, and remembered one month prior, while walking to class on a sunny day. I strolled towards class (mandatory, of course) through the bright green collegiate campus green. Guys were wearing tanks and throwing frisbees, girls were sunning themselves in bikinis, and there was that familiar springtime energy permeating through the air. I remember thinking to myself, “what a beautiful place to be”. I was outside of my apartment – sunshine, beauty, and people. I love people. I am not meant to be a monk. I was never meant to sit inside my apartment for days straight studying. I love people and the energy they bring. This is why, now that Step 1 is over, I am so thrilled to begin the next chapter of life.

The day after my conversation with Dr. B, I walked down the main street on campus to grab some dinner. I passed one of my classmates along the way. He was basking in the picturesque magenta sunset at an ice cream shop, talking to a cute girl, and smiling. I stopped to say hello. He said, “everyone needs a good break once in a while”. He was right. I picked up my food and went back to my lonely apartment to study, but this interaction stuck with me. I had been doing everything wrong for the past year.

With five weeks left until the exam, Boards and Beyond and UWorld completed, I hit pretty close to my target score on my first practice exam. I realized that the pressure I put on myself early on was completely unnecessary. I realized that I had screwed up.

The following weekend, I texted an old friend to see if he’d want to get a beer to watch the first game of the NBA finals. He said no. I texted other classmates in town. They all said no. I texted another girl I knew. She didn’t even respond. Finally, one friend did answer my plea to escape the cave.

We met at a bar, caught up, and shared some laughs. I saw a girl who I felt was attractive sitting at the bar. Now, for the past year or so, I had slowly been losing my personality and social skills. Sitting inside alone all week will do that to ya. But I decided to finally break my introverted comfort zone, so I went up and talked to her, asked for her number and all that. It went well. She was pretty. We hung out once. I had no intentions or desire to take it further than that. It was dedicated, after all. Nevertheless, I felt renewed. I started to remember. I started to recall what life was like before medical school; who I was before this year stole that from me.

I love music, much of which others find pretty weird. I love movies. I’ve seen way too many of them. I love reading. I love writing. I deeply love my friends and family. I love meeting new people, hearing their stories, and connecting with others. These are the things that define me. Not some three digit number churned out based on my responses to 280 multiple choice questions.

I realized that this station in life –the isolation and despair– it was temporary. When you succumb to those feelings, it can be hard to see past them. But from that point forward, I knew it was almost over.

I took my test. I think I’ve opened my computer roughly five times in the weeks since taking the test. Nearly each day has been spent with friends. Grilling with the family. Swimming. Playing basketball. Going to bars. Staying up until five in the morning telling stories and laughing from the heart. Waking up, working out, and doing it all over again.

Yes, when we hang out with the old crew, there is a void. The loss of our most beloved member will never be forgotten. No one ever forgets. You don’t just “get over it”. But the tears turn to laughs as we keep his memory alive by telling stories that will last a lifetime. This is grieving. This is how you move past a tragedy. In the company of friendship. Not by locking yourself in your apartment and pretending it doesn’t exist.

I should have talked to someone. I wasn’t right. None of us were. And it slowly but surely ate me alive. So if there is one request I must make to you, it is this –  if you are ever going through a hard time, if there is something on your mind that you just can’t shake, and if you have experienced any sort of personal tragedy in medical school, please talk to somebody. I’ve always been a guy at heart and sharing my feelings has never come easy to me. Especially when those closest to me didn’t care to hear them. But there are people out there who do care. People who can help you. I never imagined I had so much to gain by talking to someone. Hindsight is so euphoric. But I deeply, deeply wish I had reached out a long time ago.

While these past few weeks have been an absolute joy, I am excited to start my clinical rotations. I am not naive. Maybe a little, but still. I know that I’ll have hard times. I know that I’ll screw up, say stupid things, and look like an idiot. That’s okay. I’m excited to learn. And I’m excited to be in the presence of other people again.

See, I may not have been able to realize it at the time, but these hardships in life are blessings. They are learning experiences. Not now, and perhaps not any time soon, but someday – someday, I’ll be able to look back upon this phase fondly. I’ll know that it taught me lessons. I’ll know that if I made it through that, I’ll be alright.

 

Tomorrow I will receive my USMLE Step 1 score. Pretty crazy to think about. I know that no matter what, I overcame a difficult time, I left nothing on the table, I gave it my all, and I’ll do my best to be a great doctor someday. That’s what it’s all about.

If you take nothing else from my ramblings, please remember to do two things. Keep in touch with those you love. And be kind to yourself.

Goodbye Step 1.

Sincerely,

J Soze


 

I will be in Chicago today, July 11th until Saturday. If any readers are in town, shoot me a message. Let’s a get a drink. We deserve it.

Send me a message on Twitter @JordanSoze

 

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