The devastation of the SOAP, aka The Scramble

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.