count on futures...

so at last, the USMLE has come and gone. I'm somewhat ashamed to think that I had spent the week studying a fair amount - and clearly could have studied more - and left the test with an unsettling feeling that I could have done better. I'm not sure if that is just a gut reaction of if that is the result of kind of the recent emergence of my previously inhibited type "A" persona. it really is an ugly side of me that I usually keep in check - mostly through keeping occupied and interacting with my friends. it just seems like the past few weeks have been devoid of either amusement and thusly it was able to rear its ugly head.

I left the testing center today with a lingering feeling of uneasiness, a fraction of what has been evolving over the past few days. it is really just that feeling that my future is absolutely out of my control and is solely in the hands of people I will never meet. it is now clear to me that this will not change regardless of the amount of stress I burden myself with throughout the upcoming days. so now that I have reconciled this, why is it that I still feel like I could be happier?

I guess it is the lingering feeling that things are rapidly changing around me. sure, I'm committing myself to a future in emergency medicine so I should be capable of handling change. it is just that in the arena of emergency medicine, I expect the unexpected. I anticipate every possibility. it is in the social atmosphere that I feel the most inept. how do I interact with people? exactly where does that fine line that separates selfish and sacrifice fall? how can I be both supportive and assertive? at what point does sacrifice become submission? yes, I seem to be rambling, but when I am left alone to my thoughts, these are the themes that run through my head. life seemed simpler a year ago and I can't say exactly what has changed. it just seems like my mind has been preoccupied with these conflicts for the past week. I don't know how they haven't come to mind before, but I hope that their resolution will not only induce spiritual growth, but also allow me to become less conflicted and more focused.

so, as it is 2:15am in Arizona now, I seem to be slightly relieved. I know that I have good friends surrounding me whom I can depend upon. though I may have wavered in my beliefs before, I feel confident that I have friends that would also gladly offer the same level of sacrifice and altruism that I would for others. though these are not bonds I share with many, I will always protect them with every conscious action and thought. despite my often labile and swaying emotions, these are the people that I will seek out the moment I open my eyes in the morning. despite the rapidly changing social climate here, I hope that these ties never diminish. even now, it is hard to imagine my life without my friends here. as described earlier, the feelings of isolation and abandonment can be overwhelming. it is my hope that I can recall this moment when I begin to feel frustrated or forgotten.

train conversations are passing me by...

the last few weeks have been filled with such absolute ups and downs that I've almost felt the necessity to stop, look in the mirror and watch as my hairs either turn grey or start falling out. can you believe it? I'm a mess.

I remember saying three weeks ago that after ERAS was submitted and COMLEX was over, my stress would seemingly taper and dissipate after I took my USMLE. well, it appears that moment has arrived and it doesn't seem to be getting any better. I have never felt like such a novice in my life and quite frankly its a bit unnerving. I'm so used to traveling at the pace of life and adjusting so effortlessly to obstacles that not knowing what to do and who will stand beside me has become evidently unsettling.

I suppose I was just naive to believe that fate would continue to prepare everything for me and I could continue to coast through my career. this became startlingly apparent when my evaluation for my ER rotation in Peoria arrived in Phoenix. it wasn't catastrophic by any means, but I am basically forced to settle for "good" instead of "great." at this point, I don't know how much this will truly affect applications and interviews, but I have been so used to excelling that this came as a bit of a shock. I left Peoria feeling like I was on top of the world and the evaluation was a stark reminder that sometimes my standards can fall short of other's expectations. on the other hand, the first of a couple letters of recommendation have filtered in and I am very fortunate to have had attendings be gracious enough to extend their support. it is upon my interactions with these faculty that I can bolster my hopes for a future in emergency medicine.

so, as that news struck, many things just seemed to tumble and grow on top of another. I started to notice the conscious need to keep myself focused, reigning in the scattered thoughts about grades, the future, interviews, other rotations, and the tangential aspects of daily life. waking up became a chore as I knew I would have to wage war against the denizens of the highway at 7am. stagnancy on the highway was just as taxing as weaving from lane to lane trying to get to the VA faster. my frustration would continue to multiply time crept away while I sat helpless in my car. fortunately, this morning dose of infuriation would be reduced when Ben and I began carpooling and taking advantage of the HOV lane. this, however, would bring about its own set of problems. while at the VA, the mornings would speed by and lunch would mark the end of a productive shift in the clinic. however, it almost always heralded the beginning of continued frustration.

I came to realize in the past few weeks that I am clearly obsessed with the concept of time. this was obvious as I commuted in the morning, but became overtly clear during the afternoons in clinic. while carpooling in the morning meant was hardly a sacrifice for me, I realized that there is nothing more frustrating than being stuck in the VA, staring at the beautiful weather just on the other side of the thick, glass windows. because there was seldom work to be done after lunch, the afternoons were fairly pointless as we sat around waiting for work to presented. this often resulted in two or three hours of wasted time and an eventual dismissal around 4pm. I know. poor me, getting done with work at 5pm. my frustration didn't come from waiting as much as the hell it must have been for Ben as he was frequently done around 3pm. I couldn't imagine the torture of sitting around that cesspool for two hours waiting for me to get done. so, suffice to say, I found myself leaving the VA with what I expect to be a colony of new gastric ulcers and possibly a new aneurysm or two.

having explained that situation, I am left to wonder, "when did I change so much?" I guess I have always hated traffic and dislike being late, but when did I ever let it take control of me? it has been a frightening realization that I have been trying to work out for the last few days. I suppose I've just been caught off-guard by how much our lives are in fact changing each day. I don't mean the small things that define 8am from 9am or Wednesday from Thursday. I realized that so many of our actions today can in fact alter our futures - not on the order of hours or days, but years, decades, and possibly entire lives.

for example, I remember submitting the ERAS application three weeks ago and making the joke that it seemed so easy. now, I think back on how crazy we were to be clicking through the site without regard of its ultimate significance. sure I researched programs and noted that I would be hopefully attending one of those programs for residency, but moving the mouse and pushing the buttons seemed like such a game at the time. apply to harvard? why not? yale? stanford? chicago? sure! its a mouse click away! it is as if some defense mechanism switched on inside me and the gravity of the situation was muted. now, the thought of waiting for residency is more daunting each day.

I'd be lying if I said I know what to expect these next few weeks. it seems like I am standing alone while the entire world is rushing past me. everyone around me is buzzing with invitations to interview while my applications appear to be hanging in limbo, likely buried deep in a pile on the tables of residency committees. it seems I haven't moved from studying in the house while the days passed and now USMLE is about a day away. the house is eerily empty at times and I am left staring at the ceiling fan, contemplating how not to self-destruct. it seems like friendly faces are rapidly shifting in and out of phase as they fly in and out of the area for rotations. the sense of stability that was once here during third-year has clearly left.

not to sound like a coward, but this sense of chaos smothers me until I am on my back in bed, looking up at the ceiling wishing it could be simple again. yes, at times it is bad enough that I wish I could just go back and repeat it again. I wish I could just step out the front door and anticipate closing my first abdominal surgery. I wish I could get lost walking in the halls of Phoenix Childrens'. I wish I could look forward to seeing all our friends at Rosie McCaffrey's on Friday night. obviously I can't turn back time, but I hope that this oppressing exasperation will soon pass and I can return to work with the same enthusiasm and excitement as I did last year.