Genug with Sitting Shivah

There is a tradition among my people: when a loved one passes away we spend seven days in mourning. We call it Sitting Shivah. "Shivah" means seven in Hebrew. During this time we abstain from common daily luxuries, pleasurable activities, and even cover the mirrors so as to avoid vanity. This period is set aside  to focus not only on what we lost but to work through the pain and anger of that loss.

As of today, it's been a week since I learned that I failed my medical boards again. While it is true that this loss does not compare to the loss of a loved one, it is painful loss nonetheless. Today, it was made even more painful learning, because of the delay in passing my exam, that I will not be able to graduate with my class. So, instead of graduating in 2018 I will walk in 2019.

The pain of these compound losses strikes deep within me. The mantra "You're a failure." plays over and over in my mind. I see my family suffer financially because of my current inability to get over this hurdle.

But Shivah is over now. I can no longer afford the luxury of self-pity. The time for wallowing in depression has passed. Now is the time for action. After consulting with faculty at my medical school, as well as my advisors, my family and I have developed an aggressive plan, a new approach, so as to pass the board exam this next time, God willing. My school allows four attempts to pass before I am expelled. It is my sincere hope that I will not have to avail myself of every one of those attempts.

So, time to dry my eyes, time to let go of the self-anger, time to replace the destructive mantra of failure with a mantra of hope. If there was ever a time to "pull myself up by my bootstraps" it is now. I have wanted to be a doctor since I was six years old. I am sure not going to let one stupid test rip this away from me.

So help me God.

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Nuts!

On December 22nd, 1944, the US Army was in the Belgian city of Bastogne, surrounded by the German Army. World War II was winding down and the Germans expected an easy victory against the American F Company of the 327th Glider Infantry Regiment, 101st Airborne Division. So sure was the German Army of their pending success that they typed a formal letter to the Americans asking the Yanks to surrender. US General Anthony McAuliffe, after reading the letter, gave his now famous response to the request: "Nuts!" Indeed, the good general had his terse reply typed up in a formal memorandum and sent to the German Army. Initially they did not understand General McAuliffe's reply so the Americans spelled it out for them: they were decidedly not going to surrender. Remarkably, the US Army survived a scaled down German attack and the rest, as they say, is history.

Yesterday, I received the results of my second COMLEX step 1 medical boards exam. Incredibly, and against all odds, I failed yet again. This makes two consecutive failures of my medical boards - a profoundly negative turn of events. The discouragement and shock are intense, as you could imagine.

Now there are pressing questions: should I go on? Would I be a fool for continuing this marathon toward becoming a physician? Am I, at this point, simply putting off the inevitable reality that I simply cannot make it?

Someone once said that the true timbre of a man is determined by the manner in which he handles his failures as much as his successes and I believe this to be true. I am not under the illusion that I am not in a most difficult position. Two failures look very bad on my transcripts and are a definite big bump in the road when it comes to residency applications. On top of all of this, my family is suffering as finances become increasingly strained. Would it be fair to them for me to try yet again?

Needless to say my family and I have been in much prayer. I have consulted with one of the deans of my school and with multiple professors. My family, friends, and faculty all tell me the same thing: don't give up. Don't surrender.

I am surrounded. The enemy is pressing in on every side. I am assaulted by failure, fears, and financial strain. These formidable foes have told me to turn in my stethoscope, told me it's time to move on to something else...

Nuts!

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The Medieval Torture that is COMLEX

This post is going to be a little longer than normal.

On September 19th, I had the joy (*ahem*) of taking the Osteopathic Medicine Step 1 boards exam, the COMLEX, again. I wanted to share with you, Dear Reader, my experience that day.

I woke up early after attempting to get a full night's sleep. My family was with me as I had a high protein breakfast and they dropped me off at the Prometric Testing Center. I confess I was nervous, though not nearly as nervous as the first time. (For those who may not know, I failed my first Step 1 boards attempt). My wife prayed with me and, with that, I stepped through the glass front door of the Center.

I signed in and was assigned a small locker into which I stored my cell phone and keys. I was led into another room where a friendly if not slightly bored person asked me to turn my pants pockets inside-out, lift my pant legs to reveal my ankles, and turn about as she waved a magic wand up and down my body searching, no doubt, for some metallic tablet onto which I might have engraved two years worth of medical knowledge. After being satisfied that I wasn't a felon, I was asked to sit down next to another friendly person who scanned my fingerprints on both hands. He asked for a picture ID. I obliged. After several minutes of him scanning my ID and tapping vigorously into his computer, I was given the "go-ahead". I had cleared Security. I could take the test! Whoo-hoo!

I was given a couple of permanent markers and several plastic sheets of paper and led into a tomb-like, windowless room filled with several cubicles, each of which had an outdated computer and simple chair. I sat down, listened to some simple instructions from the friendly lady who would monitor this room for the next eight hours, and was shown a pair of earphones. After being assured that I had everything I needed, she left.

This was it. I stared at the monitor. It stared back. Months and months of study and preparation came down to this moment. I took a deep breath, said another quick prayer, and clicked on the "Start" button. The first question came up. I read it quickly, scanned the answer options and, to my delight, actually understood what was being asked of me! This was a good start.

Four hours later I had finished 200 questions and felt, honestly, pretty good. I was not anxious as I had been the first time, and I was ready for a quick lunch break. I stood, left the earphones and plastic sheets at my station, and walked out to the bored attendant. He scanned my fingerprints (just in case I had magically morphed into a different person while sitting in my cubicle. One can never be too careful), made sure I had my ID, and let me go to lunch.

In the parking lot, my wife and kids had returned and we sat in our beat-up minivan together while I quickly downed a protein bar and bottle of water. My wife wanted to know all about my experience thus far and I was happy to report that I felt pretty good. After 20 minutes and another prayer, I was back in the testing ante-room, getting scanned, fingerprinted, and ID'd. Soon I was sitting at the desk and ready to resume.

And then I hit the wall.

My shoulders started to tense, my neck started to ache and, after a couple of dozen questions, I found myself having to read each question twice to understand what was being asked. The clock seemed to supernaturally speed up as I struggled to finish on time. What was wrong? What had changed? I felt anxiety begin to gnaw at the edges of my mind. I fought it back, took a deep breath, said another prayer (I'm convinced in the therapeutic power of prayer) and pushed ahead. I read another question. What the heck was it asking? I had to look up several lab results. The clock seemed to run even faster. I finished another set of 50 questions, leaned over in my chair, stretched my back, did a quick OPP treatment on my neck, and looked back at the screen, challenging it. I would conquer this stupid thing, so help me God. I heard a truck pass by noisily outside. Behind me, another test-taker was tapping his desk nervously. Great...

An additional four hours passed and I came to the final question. By this time, I was exhausted and, honestly, I could barely force myself to care. I looked at the answer options, realized I had no clue, and quickly clicked what I thought might be the right answer. The clock told me I had a couple of minutes left. I closed the test.

I was done.

I stood. My legs and hips groaned in protest. What had begun eight hours ago with confidence and enthusiasm ended with a sense of completion and exhaustion. I stretched, waved at the poor attendant who watched me through the glass, and left the room. More fingerprints, more ID confirmation. I went to my locker, grabbed my phone, turned in my locker key, and walked out. In a few moments my family showed up, ushering me away to a celebratory dinner.

Regardless of the results, I know it is a great honor to be given the opportunity to sit for the medical boards. And I, ever the over-achiever, sat for them twice. Now my family and I wait a month for the folks at the NBOME to process and post the results. I feel hopeful (more so than the first time) that I passed and can move forward to third year rotations. There remains in me an anxiety that I may have failed a second time, an anxiety shared, I've learned, by most of my classmates who later learned they passed. I am using this interim waiting time to sleep in and spend time with my family.

Thank you, Dear Reader, for making it thus far in this, my longest blog entry ever.

I will keep you posted!

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The Evening Before Tomorrow.........Again........

This is going to be short.

Tonight is the evening before the COMLEX medical board exam - again. Tomorrow I will spend eight hours huddled in front of a computer answering long and poorly-worded questions, 400 questions to be precise, covering all that I have learned during the first two years of medical school. 

After all of the study, and the 20+ pounds I have gained since July doing nothing but eating and sitting at a desk, I am so ready to have this over. I pray that all of the time, expense, and effort will prove to be enough.

Thank you, dear reader, for your time. I will keep you posted.

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Kill it - Kill it Dead....

The beast stood there, lurking in the shadows just beyond my sight. I could hear its low growls, gutteral mutterings that communicated evil intent. My breath came in short bursts: palms sweaty, muscles tense. My mind screamed at me to run but my feet remained rooted to the earth. With a supernatural resolve I forced myself to stay. Slowly, the beast lumbered toward me, greasy sinews taunt with power, fierce jaws dazzled by a thousand teeth made silver in the shifting moonlight. I felt my hand on my sword, oddly strong and sure of itself despite the huge mass that trembled before me. In a single move I drew the blade from the scabbard and held it before me. The finely tempered steel glinted as the razor sharp tip was inches from my adversary. This was it: we were going to fight...

It's been a couple of months since I learned that I failed my medical boards exam - the COMLEX Step 1 - this failure essentially bringing my young medical career to a dramatic halt until I pass. In the ensuing weeks I have taken a boards exam prep course, spending anywhere from six to ten hours a day in intense study. I have also plowed through over 2,000 practice questions. It's been good: I have re-learned a lot and secured a better grasp on two years worth of material.

During this time, though, COMLEX has grown in my mind. Before, COMLEX was merely a test, a hurdle to be jumped over en-route to becoming a physician. Now, COMLEX is the beastly creature described above, a hulking, heaving mass of sinister and destructive intent that I must destroy. Forgive me if this sound dramatic, but I'm really starting to hate this test. It's not that I find it unnecessary, it's just that I realize that now it's "kill or be killed". I love medicine and I love people, thus I will do whatever is needed to slay this beast and move on to third year, even if it takes me longer than most.

There are 17 study days left until my exam: 17 days to re-review and sharpen my sword. With God's help, I will see this thing slain and stand triumphantly over its decaying carcass.

Thank you for your time, Dear Reader. I will keep you posted.

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Hitting the Wall at 100 Miles per Hour

FINALLY!! After so much waiting and praying and nail biting, board exam results are in! The excitement! The anticipation! My fingers moved tremulously over my phone as I accessed my results. Did I pass?

No

Wait, what? I looked again. In small type the words "Failed Exam" stared back at me. I can't believe it. I really failed.

I am shocked, dismayed, angry, in disbelief. How could I have failed? I studied for hundreds and hundreds of hours for this test. I spent nearly $1,000 on study materials. I answered countless practice questions - all for naught?

Despite everything, I did indeed fail. Thank God, I didn't fail by too much, but here a "miss is as great as a mile". Suddenly, my entire medical school career has come to a dramatic, terrible, screeching halt. I cannot move on to 3rd year until I pass this exam. More terribly, with a large family to support, I learned this morning that all financial aid is put on hold until I pass. Since it will be at least a month before I can retake the test and then I must wait four to six weeks for the results, we are now facing no less than 2 months with no income.

Failure is incredibly difficult to take. I do not blame God or my school or my teachers or the test or some random phase of the moon, etc. The responsibility for this rests firmly on my shoulders. I will give myself a day or two to mourn - to deal with my frustrations and bewilderment. Then I will hit the books once again. I WILL pass this damnable test. I WILL move onto 3rd year, even if I'm a month or two behind, and I WILL walk across that stage in two years, becoming a doctor - so help me God.

Meanwhile, there are others in my class whom also failed and who now face a couple of months of uncertainty and financial drought. I'm posting a link, dear reader, for you. This is the first time in two years that I've done this but I'm asking for money for all of those students at my school who are now without loans and without recourse. Some of them, like myself, have families to support. Please forgive me if this comes across in poor taste. That is not my intention. Rather, I want to help folks who need help now. Who knows? In the future these same folks may get the chance, as physicians, to help you. The link is here: Relief for Medical Students in Need

May God richly bless you.

Meanwhile for me it's back to the books...again...

The Great Evil....

There exists a darkness, a sinister blackness, an oily evil that oozes in like a fecund fungus. This evil is stale, silent, and overpowering, a thick force that creeps up on a person and, like a conquering virus, threatens to infect, infest, and immobilize.

What is this great evil, you might ask? It is the period of time that lay between taking your STEP 1 medical boards and receiving the results.

On May 24th I sat for my COMLEX STEP 1 medical licensure boards. It was eight hours of physical and mental anguish as I racked every corner of my brain for obtuse facts that may lead me to the correct answer. After the test was over I was exhausted but grateful that this major step to becoming a doctor was done. All I needed now was my score!

This was 41 days ago.

41 days of prayer, agony, thinking, second-guessing, consulting with my classmates, and finally, resignation. Thoughts bounce around my head:  I hope I passed. What if I didn't pass? Of course I passed! Don't most people pass? Maybe I didn't pass....after all, I'm not the smartest person in my class. Oh great, I'm a loser. Is it too late to start a career at Taco Bell? I love Taco Bell. How long will it take to pay off my loans on a Taco Bell salary? Whoa, 427 years. I better stick to this med school thing. I hope I passed.... 

It's July 4th and my classmates and I are still waiting. What choice do we have? Though it's killing us, it's profoundly out of our control so we have become resigned to our fate.

This is a great evil.....

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COMLEX + 1 Week

Remarkably, today marks one week since I sat for my Step 1 boards. It has taken nearly a week for the anxiety surrounding the boards to slowly ebb away. For many months I've been studying myself almost into a stupor. Now, abruptly, I have nothing to study. The day I got home from the boards I sat down at my little desk out of habit, ready to open my USMLE First Aid book. I stared at it dumbly, suddenly realizing I was done. I actually felt lost for a few moments. What do I do now? I thought to myself.

Since coming to this realization, I have had the extreme pleasure in spending more time with my family, doing some local teaching, and reading about those medical subjects which were a little weaker for me (can anyone say PHARMACOLOGY??). I am looking forward to 3rd year with profound excitement: finally, we get to help patients on the wards! For me, this is a "return to the wards" as I have 18 years of military medical experience in clinics, the field, and hospitals. It feels like I'm coming home.

Meanwhile, I have at least two more weeks of waiting before board scores are released. No use being anxious now - what's done is done and it is quite literally in God's Hands.

I'm grateful for getting this far and very much looking forward to the next two years and to residency beyond.

Be blessed, dear reader. I'll keep you posted.

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Tomorrow....

Tomorrow, May 24th, from 0830 hrs to (about) 1730 hrs, I will be taking the medical boards Step 1 exam: the COMLEX. This exam is eight hours long and consists of 400 questions covering everything we have learned during the first two years of medical school. Quite literally, from day one, my medical education has worked to prepare me for this event.

As you might imagine, the stress is incredibly high. Thoughts assault me: What if I fail? What if I'm not cut out to be a physician? What if I've messed up and wasted my life and spent literally hundreds of thousands of dollars for nothing? What if I fail my family? Am I crazy for trying this at my age? And on and on and on....

In the midst of all of this stress two irrefutable facts remain: 1.) God, Who is very real and very close, has been so faithful to help my family and I through these challenging times. Quite literally I would not be here if not for Him; and 2.) My wife and children and many other kind folks have been and remain a source of extraordinary encouragement and support. I am thankful for both of these facts and I feel very honored simply to have the opportunity to sit for this test.

I don't know what will happen tomorrow. I do not know if I will pass this exam. I do know I am going to throw myself at it and, for eight hours, give it everything I have.

Thank you for reading. I'll keep you posted.

That Four-Legged Evil

Never before, in my wildest dreams or most terrible nightmares, had I suspected that one day I would so loathe an object as seemingly innocuous as a chair. 

But loathe it I do. 

All I do these days is sit: I sit in my chair behind my desk and study for the boards; I sit on the couch and study for the boards; I sit at the kitchen table and study for the boards; and, if I'm feeling truly daring, I sit outside and study for the boards.

Yes, it is that time in my young medical education - STEP 1 COMLEX boards are 20 days away as of this writing. This eight hour, 400 question exam will test how much I have learned in the past two years and, if I pass, usher me into official status as a 3rd year medical student. 

Thus, like my colleagues, I spend nearly all of my waking moments studying. My tuchus is tired of sitting. The chair has become an evil taskmaster telling me to open another book, read another power-point presentation, watch another educational video.

Sometimes I look out the window and yearn to go jogging or even take a brisk walk. "No time!" cries that cursed chair and back I go to plant my derriere in that unforgiving seat.

Speaking of which, I've already taken too much time sharing this with you. Only 20 more days! I should be studying!

Hello chair.....

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Le Premier Jour du reste de ta vie....

Will you let me wax philosophic for a moment?

I turned 45 years old yesterday.

45...

I'm on the downhill slide toward 50, nearly a half a century on this little spinning globe.

I know that age is merely a number, a count of the times I've shared the earth's racing around the sun. Every day, though, I am reminded of my lost youth and the reality of being entrenched in the rigors of "middle age". At school I am surrounded by the "next generation", a hodgepodge of young people who are bright and tight and brimming with vigor. At the end of a lecture they bound out of their chairs laughing and talking while I slowly rise, knees and hips screaming in protest against the punishment of sitting for so long. My youthful colleagues go over a lesson a couple of times and move on. I read, study, reread, re-study, and pray that my aging memory will somehow retain what I need. My colleagues are looking at a good 40+ years of practice as doctors after graduation. I will be 50 by the time I finish residency.

Don't misunderstand me: I'm not jealous. I had my time as a youth and tried my best to negotiate my 20's without making too many mistakes. By God's grace, I came through okay. I would be lying, though, if I didn't say that I wish I had started this journey becoming a physician a couple of decades ago.

What is the point? Namely thus - I've learned that one is never too old to live one's dream. I've also learned, though, that living one's dream later in life brings its own set of challenges. I need to work harder than most of my colleagues merely to keep up with them. I don't have the physical stamina I once had. Is it worth it? You bet! Does it come at a cost? Absolutely. "Better late than never" is a wonderful adage but needs an addendum: "and be sure to move your joints!"

Thanks for letting me rant. I love this journey. The sacrifices are worth it - without question.

Back to the books.

Why I Wear It

In 1989 I joined the Army - the desperate attempt of an 18 year old young man to get out into the world and see more than his small hometown. During basic training in a broiling Missouri summer one of the first things done to me, besides shaving my hair and riddling my thin body with countless shots, was the granting of a new set of clothes: slightly ill-fitting clothes that I would wear for many, many years to come. They were not fancy, simple patterns of green and brown, a pair of black boots (I would spend countless hours shining to a gleaming luster) and a stiff round, billed cap which, later, proudly bore my ever rising rank.

Basic training was hard for me: grueling months of challenge and change. Through it all, though, my uniform was a source of pride, a physical reminder of what I would eventually become: a soldier. Every night I washed and pressed and hung my precious uniforms, realizing that here was a physical reminder of my transformation. Before basic training I was a civilian. At graduation (which finally came in September) I marched past the podium in precise time wearing a perfectly groomed uniform. The clothes on my back were now merely a reflection of the change that had happened within. I was different - my role in society had changed - I was now in the service of my country and pledged to defend her people even, if needed, with my very life.

Fast forward a few decades and here I am again: not quite as thin and now sporting silver hair along with my original black. This new calling is no less an honor and involves no less a life-altering transformation. The challenges are vast but the final goal remains the same: service to people with my very life. Every morning, when I don that slightly ill-fitting white coat, I am reminded that, by God's grace, I am in training to become a physician. It is an outward and vibrant symbol of a very real change happening within. Instead of weapons of war I am now learning methods for mending. This transformation is reflected in that thin white coat.

My particular medical school does not require that students wear their white coats to class. That's fine. I do anyway. It is my new uniform and a reminder, both to self and society, of my new obligations and my new identity.

This is why I wear it.