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.