Notes From The Depths

After a particularly dark day as a medical student, I decided to document my innermost feelings of despair and sadness, censoring as little as possible, so that others could experience the easy spiraling descent a student can be lost to if coping mechanisms fail or are absent. Even now, removed from the threat of that day and having passed the test I was sure I had failed, I am shocked at my words, yet I write them here to show solidarity with those who think they're the only ones:

I took a major career-defining test all day yesterday. I studied for weeks for it. It was supposed to be a comeback whereby an old guy comes off the bench and knocks out the heavyweight champion. As I was taking the exam, it didn't feel like that. At the end of the 9-hour bout, I stared stunned at the computer screen telling me the test was over. As I left the testing center, I was consumed with the thought, "What if I just failed that thing?" A passing score on the United States Medical Licensing Exam Step 2 CK is one of a number of requirements for all MDs to be allowed to practice medicine in the United States. You get 352 questions in eight 44-question chunks wherein you get an hour for each chunk. It's all on a computer screen. Some questions are long and difficult to read, requiring lengthy blood lab value interpretation or complicated math formula computation. Some have more than one answer that could be right but you only get credit if you pick the "best answer".

If you take a minute to read the question, you get about 20 seconds to make your decision. If you don't pass, you don't practice. In some states, it's one-strike-and-you're-out. In others, it's three-strikes.

I left the exam not knowing if I had used a strike. I couldn't see straight. I could hear my breathing and I could feel my head throbbing. I drove around as the gravity of the possibility of failing settled in. I felt alone. I wanted a close friend but I also wanted to be alone. I let myself into a church and as I sat on the floor praying, I fell asleep, only to wake up prostrate to the reality that the possibility of a shambled professional life was still there.

A hundred thousand dollars plus in debt and a family I had drug into yet another career-seeking fiasco - "Boys, dad couldn't pass his test and can't get a job ... oh and sorry about spending your college tuition." I wondered if it would have been better had I never been born and if it would have been better if my wife had never met me. Had I infused the boys with some kind of "failure genes" that would predispose them to fail just as their dad had failed in medicine, education, video, filmmaking, engineering [not true but it felt like it at the time], and I was going to get to live with that knowledge that I couldn't teach them how to succeed.

And my wife ... I married a woman who'd follow me to hell, I just didn't plan on leading her there. The problem with marrying "up" - and I married a Saint with a capital S - is the unworthiness - the knowing that the most beautiful thing was disintegrating due to my clumsiness, like an intricate snowflake on my warm hand. To be clear, I never wished I were dead, mostly because it would make things vastly more difficult for a woman who deserved the best, and while I couldn't give her the best [or at least that's what it felt like], it was clear that widowhood would be the worst. Boys needed a great father who was successful, but what they got was me, and at least that was better than nothing.

I wish I were anonymous. That way, no one would care when I failed. They wouldn't shake their heads and avoid eye contact with me when they saw me at some other job.

I did pass that test. I got nice interview offers all over the country.  I got a wonderful residency offer. The injustice of the experience however: for as miserable as I made myself feel during that dark time, I did not relish in the thrill of having survived and thrived (yet!). My only failure in retrospect was my focus.