The SOAP. The Scramble. The dreaded process of not matching into a residency spot, and desperately trying to find a leftover position.
It’s something that no one wants to think of. No one wants to go through it, no one wants to have to experience it. In an ideal world, we all go through medical school, interview for residency, match into the specialties we want in the locations we want, and live happy and meaningful careers.
Yeah, but if you’re picking up a theme from my life here so far, it should be that I don’t seem to exist in the ideal world. The ideal world rarely seems to overlap with the Twilly world (that’s me—Twilly).
So, I went through medical school and studied hard. I did fine. I didn’t blow it out of the water, but I didn’t drive the thing into the ditch either. I was a pretty average medical student. I took our board exam and did pretty good. I was, for the most part, pleased with how I did. And then it came time to apply for residency. Now, I knew I was a surgeon before I got into medical school. I got into medical school to be a surgeon, not to explore the idea of being a pediatrician or a psychiatrist or an anesthesiologist. I knew exactly what I wanted to do, and it involved scalpels and operating rooms and scrubs. I interviewed for my surgical sub specialty of choice, and I went on quite a few interviews. I thought I did well, but I also was in the haze of active addiction. My drug-soaked brain told me that things were going well, that the choices I was making were reasonable. For instance, the decision to pop out of one of my interviews during a break and go smoke a cigarette, at a non-smoking hospital. Yeah, it’s wasn’t one of my finer moments.
When regular people think of active addiction, they often picture folks passed out with needles sticking out of their arms. Or they picture a guy drunkenly stumbling his way to his car, about to drive drunk and wreak havoc on the neighborhood. Or they picture a bunch of stoners sitting in a basement, eating through the munchies and wasting their lives away. That’s the face of active addiction to most people. They don’t picture me in a suit, on a residency interview, explaining why I was best qualified to be a surgeon. That’s the thing about active addiction—it hides, it wears masks. It’s everywhere and anywhere. And if you think you can spot an addict, then you probably have some serious misconceptions and stereotypes about what addiction looks like. We don’t all live under bridges, we don’t all beg for change.
But I digress. I went on many interviews for residency, and I thought that they went well. I was all over the country. Buffalo, Los Angeles, Florida, New York City, Chicago, Iowa. I was all over the place. And with every interview my confidence rose. With every interview, the chances of me entering the field of my choice improved.
Entering my surgical subspeciality, or any speciality for that matter, wasn’t just about getting a job. Medicine is an apprenticeship. And entering a specialty felt more like joining a house in Harry Potter. It’s the job you want to do, but it’s also the group of people that you fit in with. It’s the personality type you mesh with. It’s your tribe. That’s not always the case, and there are exceptions and outliers. Star Trek nerds that become orthopedic surgeons, jocks that become pediatricians, and chatty personable social butterflies who become radiologists. Not all of the stereotypes are true, but there’s a bit of truth to all of the stereotypes, in my experience. So matching into a specialty to me felt like becoming accepted by your peers. It was the sorting hat spitting out your House, and the other members of your House accepting you in.
You can imagine, then, why, the Monday preceding Match Day (that fateful day in March when all fourth year medical students find out what residency programs they will be attending), when I received the message “We are sorry. You have failed to match to a position.”, was such a day of devastation.
I remember calling my mom to tell her that I didn’t match. She was with my five year old nephew at the time. I learned later that my nephew would begin to say that he didn’t want me calling my mother, because “Twilly makes you cry”.
They say it’s not personal. It’s the computer system. But I can assure you, it definitely feels personal. 16 programs saying "No thanks", even if that "no thanks" came in the form of being ranked 5th on every list, still feels like rejection, I can assure you. And maybe I'm not far along enough in my spiritual development, but rejection still feels very personal to me. Or at least, it did at that point in my life.
I remember sitting in my Dean's office about an hour after I got the news that I didn't match. The Deans get the list of students who failed to Match before students have access to it, so they knew. I remember her telling me that she was as surprising as I was. She said that of all the people that she expected to be on that list, I certainly wasn't the -----the rest of it was a blur. I choked back tears and asked her what came next.
The SOAP, formerly the scramble. It used to be chaos, I'm told. Frantically running down the list of available programs and faxing your resume all over the country, doing phone interviews, your home institution advocating for you (hopefully). But computers have made things a bit more civilized. You get a list of unfilled programs and can check the boxes of the programs you want to apply to. Programs have a period of time to review applications and do phone interviews, and then send out offers. That's round one. After people accept or deny offers, a second list of unfilled programs goes out, and the process repeats itself. I managed to secure a prelim spot at my home institution, with the help of a phone call from my Dean, and just like that, I had a job for July.
I could have gone to Match day if I wanted. There was a little envelope there for me, with my Prelim surgery year program's name written on a piece of paper inside of it. But somehow, I didn't feel in the celebratory mood. I couldn't even rally enough to go and celebrate with my friends. I was just so ashamed and disappointed that I couldn't even bear to be anywhere near Match Day festivities. In fact, my family had plane tickets to fly up and be with me on Match day. But after that Monday, when I called them distraught, they cancelled their tickets (at my request).
The Match is still a sensitive subject for me. I feel like it's a horrible way for applicants to secure positions. But I may be alone in that. Or rather, in the minority. I suppose it's something like the SATs. They may be an unfair way of getting into college. It may be a racket. But at the time, I took them and did okay, and got into college. And after that, I wasn't quite as passionate about the injustices of the SATs. I suppose it's a little like that. Generation after generation of doctors who move on and scarcely ever think about the match again, let alone become indignant over it.
Now here I am, five years later. My life has changed significantly in the past five years. I'm a completely different person. I'm no longer in the depths of active addiction. I'm coherent, clear-minded, wiser, and more mature than I was back then. But here I am, staring down the Match again. My white whale.
I wish I had a happy ending to wrap this up with. I wish I could tell you that I went through a second time and came out the other side, triumphantly. I hope that's the way this ends. I guess you, (and by that, I mean the no one reading this), will have to take this journey with me. And we'll see where the Match takes me this time.
10.29.2019
Getting into Med School
I thought I’d write briefly about getting into med school. Warning, this is not a post that has numbers and stats and algorithms for how to get in. This is just a bit about my personal journey getting into medical school in the face of some adversity. Because I was one of those kids that they said would never get into medical school.
In fact, my undergrad was so anti-my application, that they refused to write me a committee letter. At the time, I remember that feeling like the biggest blow in the world. No committee letter! How were medical schools going to take me seriously? (No one ever asked me about it.).
My undergrad’s pre-med advisor was a particularly vile woman. I remember meeting with her. I had an excellent GPA, almost a 4.0, outside of the sciences. My science GPA on its own was significantly less impressive. Maybe a 3.0? 3.5? I can’t quite remember. It’s funny, at one point in my life those numbers seemed to define me. They meant something significant about my options, and my future, and (I thought) what kind of person I was, and whether I was worthy of becoming a physician. Now I can’t even remember them. Perspective.
I remember meeting with the pre-med advisor. She looked down at my numbers and said, “Medical schools are going to look at your grades and come to one of two conclusions. You’re either bad at science, or you’re lazy. So which is it?” “Well, I have a tough semester, because I—“ “No. You’re either bad at science or you’re lazy. Which is it?” She stared me down. My mouth dropped. I realized she really was going to make me pick one of those two options. “I guess....I’m.....lazy...?” I stammered. “Then why would they want you?”, she replied. Everything after that was a blur. I remember walking out of her office in a daze, fighting back tears, as I power walked to the place I used to hide and smoke in between classes. I called my boyfriend, choking back tears, and barely managed to explain to him what happened before the tears broke. I was angry. Pissed off that she had the audacity to talk to me that way, to crush my dreams and belittle me without a second thought. I was disappointed in myself that she had the power to reduce me to tears.
“Who hires people like her?! What does she even know about getting into medical school?! She’s a fucking pre-med advisor, not a doctor!” I ranted on the phone to my boyfriend. But I remember that if there was any doubt in my mind about my path, that was the day that it disappeared. That was the day that I decided that I wouldn’t let this tiny woman crush me, that she may have had the power to reduce me to tears but she damn sure didn’t have the power to derail my dreams.
So I studied hard. I prepared for the MCAT. I got my letters in order. I prepared my application and I chose the shotgun approach to applying to med school—as many as I could afford, and anywhere in the US that I would be willing to live for four years, which was just about anywhere.
In the end, I ended up interviewing at three programs, waitlisted at one, and accepted to one. It wasn’t the one I wanted, but what I really wanted was to be a physician. And that one school that accepted me would allow me to accomplish that goal. So I enrolled.
Against the odds, I had gotten into medical school.
Did I go back and gloat? No. Someone told me, the finest revenge against your haters is to do well, and prosper.
In fact, my undergrad was so anti-my application, that they refused to write me a committee letter. At the time, I remember that feeling like the biggest blow in the world. No committee letter! How were medical schools going to take me seriously? (No one ever asked me about it.).
My undergrad’s pre-med advisor was a particularly vile woman. I remember meeting with her. I had an excellent GPA, almost a 4.0, outside of the sciences. My science GPA on its own was significantly less impressive. Maybe a 3.0? 3.5? I can’t quite remember. It’s funny, at one point in my life those numbers seemed to define me. They meant something significant about my options, and my future, and (I thought) what kind of person I was, and whether I was worthy of becoming a physician. Now I can’t even remember them. Perspective.
I remember meeting with the pre-med advisor. She looked down at my numbers and said, “Medical schools are going to look at your grades and come to one of two conclusions. You’re either bad at science, or you’re lazy. So which is it?” “Well, I have a tough semester, because I—“ “No. You’re either bad at science or you’re lazy. Which is it?” She stared me down. My mouth dropped. I realized she really was going to make me pick one of those two options. “I guess....I’m.....lazy...?” I stammered. “Then why would they want you?”, she replied. Everything after that was a blur. I remember walking out of her office in a daze, fighting back tears, as I power walked to the place I used to hide and smoke in between classes. I called my boyfriend, choking back tears, and barely managed to explain to him what happened before the tears broke. I was angry. Pissed off that she had the audacity to talk to me that way, to crush my dreams and belittle me without a second thought. I was disappointed in myself that she had the power to reduce me to tears.
“Who hires people like her?! What does she even know about getting into medical school?! She’s a fucking pre-med advisor, not a doctor!” I ranted on the phone to my boyfriend. But I remember that if there was any doubt in my mind about my path, that was the day that it disappeared. That was the day that I decided that I wouldn’t let this tiny woman crush me, that she may have had the power to reduce me to tears but she damn sure didn’t have the power to derail my dreams.
So I studied hard. I prepared for the MCAT. I got my letters in order. I prepared my application and I chose the shotgun approach to applying to med school—as many as I could afford, and anywhere in the US that I would be willing to live for four years, which was just about anywhere.
In the end, I ended up interviewing at three programs, waitlisted at one, and accepted to one. It wasn’t the one I wanted, but what I really wanted was to be a physician. And that one school that accepted me would allow me to accomplish that goal. So I enrolled.
Against the odds, I had gotten into medical school.
Did I go back and gloat? No. Someone told me, the finest revenge against your haters is to do well, and prosper.
Residency Interviews
So, I recently came back from a residency interview. It was my first since losing my job. Being back there was a big deal for me, because there was a really long period of my life where I was sure I would never make my way back to medicine. I was sure my career was permanently over.
There are a lot of doctors in recovery. In fact, there’s even an international conference for doctors in recovery! But, when I got fired from my residency position, I didn’t know any of that. I thought that I was all alone. I was sure that I was the only one horrible enough to do what I did. The only one irresponsible enough and dumb enough to get caught up in addiction. To go from just having fun every now and then, blowing off some steam to having a “habit”. I thought of it as a personal failure, a moral deficiency on my part. There was something deeply wrong with me, fundamentally, as a person, that caused me to do the things that I did, addiction or not.
The thing about addiction, though, is that it takes us places that we wouldn’t normally go. And by that I mean that I found myself on streets in the Bronx at the wee hours of the morning that I had no business being on, but I also found myself in depths of misery that I had not previously thought possible. And in that place, in that miserable nebula in which I existed, the only thing that mattered was to keep using. Keep shoving more and more pills down my throat, keep chasing the Bolivian. I didn’t want to feel anything. I didn’t want to feel my emotions—my pain, my disappointment, my insecurity, my fears. I couldn’t face any of that, and so I longed for oblivion. It became the most important thing in my life. I wasn’t using to get high anymore, I wasn’t using for fun anymore. Fun had ended a long time ago. I was using to survive.
Nothing mattered more than that. And so I made decisions that put my entire career in jeopardy without a second thought. In an instant I decided to do things that could have taken away my livelihood and my freedom. I put other people in jeopardy, without a second thought. Because in that space, the only thing I cared about was getting the next one. When I had a pocket full of pills, I could fool myself into thinking I wasn’t an addict. But when they started to dwindle, when the fear started to set in about running out, I could feel myself willing to do anything to get more. And I did.
I’ve come a long way since those days. My life, thankfully, doesn’t look anything like that anymore. I am not a slave to any substance today. I have some self esteem today. I can look myself in the mirror, face what life brings, and do it without having to cower behind a chemical shield. I’ve come a long way. I’ve done a lot of work on myself, and I’m proud of the person that I am today. But I still carry the weight of the things that I did in my addiction.
Thankfully, I didn’t hurt anyone. I didn’t injure any patients, or directly harm anyone else, to the best of my knowledge. But I carry my deeds with me, and I’m working on forgiving myself.
So, my dear audience of none, you can maybe now appreciate the magnitude of me, sitting in the conference room, awaiting my six residency interviews. I waited until the coordinator came and walked me to the rooms, where I had 15 minute interviews that either felt devastatingly long or foolishly short. I got asked a lot to explain my past, as expected. But I did so with my head held high.
But a few people brushed over my history, or had unexpected comments:
“Everyone goes through personal struggles. Not everyone goes through them so visibly, but everyone goes through it. I admire your transparency, and the way you accept responsibility and don’t try to hide it.”
“In my opinion, you deserve a second chance. You deserve to make it back.”
“How do you want me to advocate for you to the admissions committee?”
But regardless of all that, the idea of just sitting in that seat again, of having been invited by someone to come and interview for their program was a big moment for me. And I treasured every minute of it.
I don’t know what the outcome of the Match will be. It didn’t do me any favors the first time that I went through it. But here we are again. Who knows what will happen? I’m just going to trust in my higher power, and take it one day at a time.
There are a lot of doctors in recovery. In fact, there’s even an international conference for doctors in recovery! But, when I got fired from my residency position, I didn’t know any of that. I thought that I was all alone. I was sure that I was the only one horrible enough to do what I did. The only one irresponsible enough and dumb enough to get caught up in addiction. To go from just having fun every now and then, blowing off some steam to having a “habit”. I thought of it as a personal failure, a moral deficiency on my part. There was something deeply wrong with me, fundamentally, as a person, that caused me to do the things that I did, addiction or not.
The thing about addiction, though, is that it takes us places that we wouldn’t normally go. And by that I mean that I found myself on streets in the Bronx at the wee hours of the morning that I had no business being on, but I also found myself in depths of misery that I had not previously thought possible. And in that place, in that miserable nebula in which I existed, the only thing that mattered was to keep using. Keep shoving more and more pills down my throat, keep chasing the Bolivian. I didn’t want to feel anything. I didn’t want to feel my emotions—my pain, my disappointment, my insecurity, my fears. I couldn’t face any of that, and so I longed for oblivion. It became the most important thing in my life. I wasn’t using to get high anymore, I wasn’t using for fun anymore. Fun had ended a long time ago. I was using to survive.
Nothing mattered more than that. And so I made decisions that put my entire career in jeopardy without a second thought. In an instant I decided to do things that could have taken away my livelihood and my freedom. I put other people in jeopardy, without a second thought. Because in that space, the only thing I cared about was getting the next one. When I had a pocket full of pills, I could fool myself into thinking I wasn’t an addict. But when they started to dwindle, when the fear started to set in about running out, I could feel myself willing to do anything to get more. And I did.
I’ve come a long way since those days. My life, thankfully, doesn’t look anything like that anymore. I am not a slave to any substance today. I have some self esteem today. I can look myself in the mirror, face what life brings, and do it without having to cower behind a chemical shield. I’ve come a long way. I’ve done a lot of work on myself, and I’m proud of the person that I am today. But I still carry the weight of the things that I did in my addiction.
Thankfully, I didn’t hurt anyone. I didn’t injure any patients, or directly harm anyone else, to the best of my knowledge. But I carry my deeds with me, and I’m working on forgiving myself.
So, my dear audience of none, you can maybe now appreciate the magnitude of me, sitting in the conference room, awaiting my six residency interviews. I waited until the coordinator came and walked me to the rooms, where I had 15 minute interviews that either felt devastatingly long or foolishly short. I got asked a lot to explain my past, as expected. But I did so with my head held high.
But a few people brushed over my history, or had unexpected comments:
“Everyone goes through personal struggles. Not everyone goes through them so visibly, but everyone goes through it. I admire your transparency, and the way you accept responsibility and don’t try to hide it.”
“In my opinion, you deserve a second chance. You deserve to make it back.”
“How do you want me to advocate for you to the admissions committee?”
But regardless of all that, the idea of just sitting in that seat again, of having been invited by someone to come and interview for their program was a big moment for me. And I treasured every minute of it.
I don’t know what the outcome of the Match will be. It didn’t do me any favors the first time that I went through it. But here we are again. Who knows what will happen? I’m just going to trust in my higher power, and take it one day at a time.
10.28.2019
Teaching
I am currently teaching a bunch of undergrads about the arteries of the body. They’re dissecting minks and complaining about how gross the smell of formaldehyde is, and how they’re sure that they’re going to die or get cancer from the fumes. Suck it up, buttercup, is what I want to say. But instead I say something compassionate and kind.
I showed them cadaveric dissections of the femoral artery, common illiacs, abdominal aorta and major branches, and they were thoroughly unimpressed. Usually, I manage to get them to dissect for about ten minutes before they lose interest and look at me for some guidance. “Teach me about blood vessels!” But I did! “Put the knowledge in my brain, though!” But I did as much as I can do save coming to your house and reading you a bedtime story about blood vessels.
I just gave them instructions to do something educational. Of course, they want to go home and do this on their own. I do too. But, I have a responsibility to their education, or whatever. Also, lab is supposed to be two hours and we’ve been here for 70 minutes.
I’m so ready to go back to residency.
I saw my orthopedic surgeon today. (I didn’t tell you guys why I have an Orthopedic Surgeon, that’s for another time). But he works at the institution that I have a surgical interview at next month. I asked him to put a good word in for me—to nudge some of the right people. He said he would. I kind of believe him.
But I’m also trying to just let things be and trust that they’re going to unfold as they’re supposed to. Asking him to put a word in for me is reminiscent of my previous attempts to manipulate people into doing things, and control situations and move people around like chess pieces. I’m trying to be less like that person, and more like a person who trusts in their higher power, and trusts that the outcome is going to be what it is supposed to be.
That shit is hard, though. Third step stuff, if anyone cares.
Alright, Im babbling, and I should actually teach something. I’m out!
I showed them cadaveric dissections of the femoral artery, common illiacs, abdominal aorta and major branches, and they were thoroughly unimpressed. Usually, I manage to get them to dissect for about ten minutes before they lose interest and look at me for some guidance. “Teach me about blood vessels!” But I did! “Put the knowledge in my brain, though!” But I did as much as I can do save coming to your house and reading you a bedtime story about blood vessels.
I just gave them instructions to do something educational. Of course, they want to go home and do this on their own. I do too. But, I have a responsibility to their education, or whatever. Also, lab is supposed to be two hours and we’ve been here for 70 minutes.
I’m so ready to go back to residency.
I saw my orthopedic surgeon today. (I didn’t tell you guys why I have an Orthopedic Surgeon, that’s for another time). But he works at the institution that I have a surgical interview at next month. I asked him to put a good word in for me—to nudge some of the right people. He said he would. I kind of believe him.
But I’m also trying to just let things be and trust that they’re going to unfold as they’re supposed to. Asking him to put a word in for me is reminiscent of my previous attempts to manipulate people into doing things, and control situations and move people around like chess pieces. I’m trying to be less like that person, and more like a person who trusts in their higher power, and trusts that the outcome is going to be what it is supposed to be.
That shit is hard, though. Third step stuff, if anyone cares.
Alright, Im babbling, and I should actually teach something. I’m out!
Who dat is?
Who am I?
Well, I’m a blogger. I’m a sister, a fiancé, a daughter, a doctor, a teacher, a recovering addict. I’m a lot of things. I try to blog and I always seem to forget about my blogs. But I’m going to try to hold on to this one. Maybe someone is interested in what I have to say.
I just got back from a residency interview for Interventional Radiology. It was a fantastic program, a fantastic hospital, people who seemed to love their jobs, their city, and their colleagues. You could tell that people were being genuine—that midwestern honesty and charm, and it was infectious.
This was my first interview on my way back to medicine. I guess I should give you some background. I was a resident. And a few years ago, I was terminated from my program. I did things in my active addiction that caused me to behave really stupidly, irresponsibly, and foolishly. And it cost me my job. There was a time that I thought that I would never have the opportunity to come back to medicine. I thought that I had given away the right to be a physician anymore, to practice medicine.
And then I met a bunch of doctors in recovery. I met a bunch of doctors who had, in their active addiction, done any number of crazy things that cost them jobs, families, patients, reputations, etc. And they reassured me that there was a path to salvation, but that path started with me dealing with my issues and working on myself. They told me that my question back then of “Will I ever get my job back?”was completely premature, and missed the point entirely. The question should have been, “What’s wrong with me, and how do I fix it?”. I eventually did get around to asking the right question, and working on the answer through recovery.
And so I started to stop hating myself. I began to stop beating myself up every day.
And now here I am. Back to applications. Back to exposing yourself, warts and all, in front of a committee of folks and saying, “Please take me”. And the fact that I was even invited to sit in that seat was enough to move me and make me pretty emotional.That some of the faculty members addressed their sincerest hope that I make it back to medicine and told me that they think I deserve a second chance was almost enough to put me in tears.
I veered off. I was supposed to be talking about who I am, introducing myself and the like. Well, that’s probably all I’m in the mood to do right now.
Well, I’m a blogger. I’m a sister, a fiancé, a daughter, a doctor, a teacher, a recovering addict. I’m a lot of things. I try to blog and I always seem to forget about my blogs. But I’m going to try to hold on to this one. Maybe someone is interested in what I have to say.
I just got back from a residency interview for Interventional Radiology. It was a fantastic program, a fantastic hospital, people who seemed to love their jobs, their city, and their colleagues. You could tell that people were being genuine—that midwestern honesty and charm, and it was infectious.
This was my first interview on my way back to medicine. I guess I should give you some background. I was a resident. And a few years ago, I was terminated from my program. I did things in my active addiction that caused me to behave really stupidly, irresponsibly, and foolishly. And it cost me my job. There was a time that I thought that I would never have the opportunity to come back to medicine. I thought that I had given away the right to be a physician anymore, to practice medicine.
And then I met a bunch of doctors in recovery. I met a bunch of doctors who had, in their active addiction, done any number of crazy things that cost them jobs, families, patients, reputations, etc. And they reassured me that there was a path to salvation, but that path started with me dealing with my issues and working on myself. They told me that my question back then of “Will I ever get my job back?”was completely premature, and missed the point entirely. The question should have been, “What’s wrong with me, and how do I fix it?”. I eventually did get around to asking the right question, and working on the answer through recovery.
And so I started to stop hating myself. I began to stop beating myself up every day.
And now here I am. Back to applications. Back to exposing yourself, warts and all, in front of a committee of folks and saying, “Please take me”. And the fact that I was even invited to sit in that seat was enough to move me and make me pretty emotional.That some of the faculty members addressed their sincerest hope that I make it back to medicine and told me that they think I deserve a second chance was almost enough to put me in tears.
I veered off. I was supposed to be talking about who I am, introducing myself and the like. Well, that’s probably all I’m in the mood to do right now.
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