GUEST BLOG: THE HIGHEST OF HIGHS AND LOWEST OF LOWS, A MS4 PERSPECTIVE AFTER FAILING TO MATCH

*The Highest of Highs and Lowest of Lows*

A 4^th year Medical Students Perspective after Failing to Match

*Trigger warning: suicidal thoughts*

Before I get started with writing, I just wanted it to be known that I was asked by a dear friend and colleague to write this for her blog. Full disclosure: writing has never been a gift of mine, but what follows is coming from a place of honesty and truthfulness. I hope someone out there can learn from my experience and mistakes. And for those of us that felt the devastation and heart break that I felt on that day, hopefully you know you are not alone.

Match Day is synonymous with a celebration for most medical students from the moment we enter medical school. It is the day you learn where you get to pick up and move to next in the chapter of learning the art and science of practicing medicine. It is what people have spent many nights dreaming about for countless years − when all the hard work, sleepless nights, exorbitant amounts of stress all go away because it paid off. The sacrifices of missed family vacations, weddings, birthdays, parties all makes a little bit of sense for that moment in time. Well, what happens when that day goes from what is supposed to be one of the happiest moments of your medical career to one of the worst days of your life in the blink of an eye?

As I’m sitting here in this quiet little coffee shop reflecting about my recent graduation and last 4 years of some of the most grueling times, I can’t help to be to be a little retrospective. Some of my fondest memories come from block parties after finishing difficult exams and times when we spent tirelessly trying to memorize structures in anatomy lab. I’ve met lifelong friends in medical school and even though we may not see each other for very long time, we pick up right where we left off. I’ve met colleagues from all walks of life and diverse backgrounds. I’ve had great mentors and plenty of help along the way.

I was asked in a few of my residency interviews “What is the most difficult decision you have ever made in life thus far?” During those interviews I didn’t have a good answer, but I answered it honestly as best I could at the time. I said something along the lines of “That is a difficult question for me to answer, I’m not trying to brag or be obnoxious, but up until this point in life I have not made any life changing decisions. I have been fairly blessed and fortunate. My parents provided well for brother and I. My grandparents are still living and healthy, my parents are alive and healthy. I’ve had everyday stress with school and work, but other than that I haven’t made any life changing decisions that really affected me or other people significantly.” At that point in my life it was the truth. I never picked up and moved across the country, I was lucky enough to do both undergraduate and medical school in my home state. I wasn’t married and didn’t have any children. I’m not saying all aspects of my life were a wide-open layup on a fast break with no defenders in sight, but compared to what some classmates and friends went through it wasn’t even comparable.

I applied for one of the more difficult specialties to match into, but I knew that going into it and was appreciative of the opportunity to prove I belonged at a program. I knew my board scores and class grades were good, but that is only one part of the puzzle. People matched into the specialty I applied for with higher scores/grades than me and people also matched with lower scores/grades than I had. You still must show up, be likeable, and work hard. You are the first one to show up and the last to leave the hospital on away rotations.

The first thing you must know going into interviews and away rotations is that many things are ultimately out of your control. Speaking for myself this may be the hardest thing to come to grips with. We, for the most part, are all severally Type A people we have our days planned out down to the minute; how much time are we going to spend at the gym and dinner so that we can make sure to study for 6 hours in the evening. I’m sure I’m not the only person that said, “If I wake up at 7:30 I can do a block of questions on UWorld, review them, do 5 DIT videos, eat lunch quickly, make it to the gym for an hour and then get back to studying for the rest of the evening with a 30-minute break to decompress at the end of the day.” But I digress, going into my first away rotation I was notified 2 weeks prior to leaving that they were no longer taking students for this cycle. This brings me to my first mistake. Have a Plan A, Plan B, and a Plan C for rotations because I wasn’t the only student scheduled to rotate at that institution and it wasn’t the only institution that had something like this happen. I did not have a backup plan and ended up having to just pick up a last minute required rotation. The result is I went into my next away rotation at a place that I really liked, but I was far behind the other students in amount of knowledge I had in that field. I was starting my first away when most other students were on their second or third full month. The rest of my away rotations went much more smoothly, but it can happen at any time. All-in-all I think I did well on my rotations, there will always be things you can improve on and be better at, but I learned as much and worked as hard as I could every day.

I had a fair number of interviews in my specialty of choice. I had some good interviews and some interviews that I left knowing that there was no chance I would match at that hospital. It happens you are nervous, around people you have never met before who are critiquing every word that comes out of your mouth. This is tying into lesson number two shortly. After one of my interviews I received a call from a chief resident that I had met on an away rotation and subsequently spent a lot of time with. This program had also been the program that I was hoping and praying that I would end up at. He called me and we talked for about 15 minutes about how I was one of their top choices they had and residents and faculty both liked me. He relayed the message from the program director that they really wanted me at this program and it was the best news I had received. A weight was lifted off my shoulders at that moment in time and I had the best night of sleep I had in months. It ultimately led to mistake number two.

After getting this phone call, I fell out of touch with many of my other interviews. I didn’t follow up with thank you notes or phone calls telling them I was interested anymore. I had gotten good feedback from a handful of other programs, some that I rotated at and some that I did not. I was also told in that same phone call to cancel my remaining interviews, I explained that I only had a few more and would treat them more as vacation than serious interviews. If you can take one thing from this NEVER NEVER NEVER cancel your interviews because a program tells you too. This isn’t meant to get anyone in trouble this is just the truth so that no one can fall for the same traps I fell for because not one person told me that things like this can happen. Lesson number two, tell programs what they want to hear. They are playing a numbers game the same way you should be playing a numbers game. If you get a call from your top choice you can still thank them and rank them number one, but keep in touch with the other programs too. If a program has 4 spots to fill chances are they are calling 5-6 people telling them all the same thing. At the end of the day, they don’t want those spots going unmatched, but you also don’t want to over step your boundaries. It is a very fine line that no one really tells you about during your medical school education.

I didn’t sleep much the night before Match day, being nervous and excited at the same time is a strange feeling. It led to lots of tossing and turning all night. I even tried to sleep in more than is normal for me so that I didn’t have to anxiously wait around all day to find out if I matched. So, what happens when you think for two months you are going to your number one choice residency program and then you get an email saying you didn’t match? My first reaction was that can’t be right they sent the wrong email to me, so then you double check and read it slower the second time and that second time it’s as if someone is slowly laughing while pulling a knife out of your chest. First you get a little short of breath, then become tachypneic and tachycardic, your chest begins to get tight and next thing you are in a full-blown panic attack. Wondering what do I do next? Where do I go from here? You feel empty throughout while everyone is posting on social media they matched and how everything works out. It’s a gut check for sure. I was happy for my friends and absolutely miserable at the same time.

Medical school orientation ─ where some of the deans play good cop, but there is always the token bad cop. Telling you about how you would lose so many people from your class and that some people just weren’t cut out to be in medical school. I sat through all those not really paying attention because to me failure wasn’t an option. I was the first of my family to attend medical school, I had to make them proud, I had to do well. Failure wasn’t something I could even bother hearing, but now some three and a half years later FAILURE was the only thing going through my head. The countless hours spent studying physiology, anatomy, biochemistry – was it all a sham? I had failed. I was a failure. My label for myself from then on would be a failure. That’s all I could think about for days. On rotations I wasn’t the same anymore I used to be outgoing with patients, now all I wanted to do was go home. I had no interest in learning, being in the hospital. I was a failure. I couldn’t shake that feeling for weeks I didn’t enjoy hanging out with my friends. I displaced my attitude on my family and friends who had done absolutely nothing, but support me. This was a foreign feeling to me, I have never really dealt with depression. I was at the Lowest of Lows. I didn’t know what I was doing with my life. Where I was going. Had this just been the biggest most expensive mistake anyone one has ever made?

During my 1^st year of medical school, I remembered reading an article that made national headlines about a 4^th year student who was only months away from residency who committed suicide. I read the articles and national news stories that accompanied. My reaction was not what it should’ve been. I remember questioning, “How and Why?” He just matched was on the brink of graduating medical school and starting his career. In his shoes, some three years later, I now know exactly how he felt. Defeated, unable to see the light at the end of the tunnel, aimless with exponential stress building with every moment that went by. Seemingly having no way out. Two months ago, I had felt relieved and was waiting anxiously for it to be official, now I was in a dark place that kept expanding. It felt as if I was in a blackhole with no light escaping, no noise being heard, my once outgoing personality had faded into a jaded, scorned shell of what it once was. It all made sense in that moment of how a once happy medical student doing well in his studies, loved by his peers could succumb to such feelings.

Just writing this I am trembling and quite lucky that I made it out with the help of some wonderful people. In medical school, we learn about how to deal with suicidal patients by asking a certain set of questions. Are you going to harm yourself? Others? Do you have a plan? Would you really do it? Do you have access to firearms in your home? To answer those questions, at my darkest moment I was going to do it. I had a pretty fool proof plan as well. I was going to wake up the next morning and do it. I was prepared in that moment to give up. All I could keep thinking about was how I failed. I would always be looked down upon by my peers and colleagues because I scrambled. I couldn’t kick that feeling. Thankfully, I had a guardian angel looking over me and one of my friends answered their phone and listened to me rant for an hour and ultimately talked me off the ledge. I have great friends and could talk it over with several of them and slowly over time my feelings began to change.

“Success is stumbling from failure to failure with no loss of enthusiasm.” - Winston Churchill

As I think back to my residency interviews, I can only imagine being asked right now “What is the hardest decision you have ever made?” My answer now, with zero hesitation, would be my decision to move on with my life after being overwhelmed with not matching. Learning to accept my failures and mistakes and use them to my advantage, hopefully making me a stronger person in the long run. In just a few short weeks, I begin residency in a great program; not in the specialty I originally applied, but one in which I thoroughly enjoyed before and during medical school. I am anxious and nervous about starting intern year, but I am confident that it is going to be a challenging and overwhelming at times, but I like many others of you will overcome and we will become great physicians in the very near future.

I hope most you never have to deal with what I dealt with, but every year it happens to great candidates who deserve the world. It is going to suck for a little while. I just hope you have friends as great as the friends I have. There are always people you can talk to and just know it even when the walls are closing in you always have a choice to do great things.