I have always been shy, well, not just shy, but painfully, exceptionally, extraordinarily shy.  I have a deep, irrational fear of rejection, the technical term is social phobia.  One on one, given time to feel out absolutely no threat, I can interact with others very well.  In a new situation, or particularly with groups, I am paralyzed.  It has haunted and hamstrung me most of my life, but never at anytime more than when I decided I might have the ability, the drive, and the heart to be a physician.

     I knew I could take tests.  Interacting with teachers or professors certainly never happened,  but tests, that I could do.  So I focused on what I was good at and had some very high marks, yet somehow they never seemed high enough to be safe.   I struggled along to fluff up my application with community service.  I volunteered with hospice, did a few other short term things, worked at a free community clinic, all of which were actually very moving and powerful experiences, but brief.  I never stayed long enough to get a really good reference.  I  became an expert at finding the holes in my experience.  It is extremely difficult to sell  oneself oneself to a Medical school if they feel they are faking it the entire way.

     I applied to 20 schools, afraid to bug them about my application or indicate interest.  I did only 3  interviews, performed in them very unevenly, managed to be waitlisted at 2 schools, reapplied a second time focusing entirely on those two, bombed the interview at one and managed to sneak in (actually I was assured they thought quite highly of me) at the other.  My medical career was born.

     In my mind, I had fooled them.  I slipped by the gatekeepers whose job was to sift out “losers” like myself.  I did quite well with the first two years of Medical school which were all academic.  I was a miserable third year for the most part.  Surgery in particular was a meltdown month in which the fact that the resident had her own breakdown, could not get along with a single person on the team, and was reported abusive, gave me a “benefit of the doubt” and a pass.  Otherwise, I learned to keep a low profile and slide along.  What I did not learn to do was to become comfortable in my own skin, put patients at ease, and feel like I had a clue doing a physical exam or patient presentation with clinical reasoning.

     There was only one exception–kids.  I loved the physical exam with them.  The intimidation factor was not there and I could let my goofy self out with them.  I had the patience and demeanor to get a lot farther with them than many other students.  My first exposure to them was in Neurology, where I had the luck of being assigned to the Children’s Hospital.  I fell in love with it.  I was fascinated by it, I was good at it, I found I did well with children that no one really felt comfortable around.  Best of all, there was a massive shortage of pediatric neurologists.   They were excited just when you showed interest.  I found my calling in medicine.  I found something I loved and knew I could do well.  My entire fourth year was spent either with kids or in neurology electives.

     I still paced around the hospital for 20 minutes before worked up nerve to ask a nurse where a patient or their chart was.  I still never woke up patients.  I still was terrified of calling anyone on the phone to chase lab results, make sure tests were scheduled, etc.  In short I was very compromised by my phobia.

     I  interviewed at every  pediatric residency I applied to, too many actually.  I found they came in two flavors, large  prestigious complexes with large subspecialty faculties and smaller, close knit programs, usually missing child neurology.  Pediatric neurology is the red headed step child of pediatric subspecialties.  It is claimed by neither Neurology or Pediatrics in training.  It requires a partial residency in pediatrics, after which you can leave and start a specialized neurology residency.  The leave early part, screws up the politics.  I ranked five programs with both pediatrics and child neuro programs, I told four of them my detailed career plans, I kept the fifth as a fail safe, in the dark.  All the programs I felt best about, I would likely have had to move a second time to start neurology.  I really don’t like transition so I ranked these against my gut feeling six through ten.

     For the uninitiated, the Match is a system whereby residencies interview a great swaths of medical students, medical students interview with many residencies and the two parties form wish lists, ranking each program or student by fit for the program.   The fate of the students and the programs is then determined by a computer, which optimizes the pick so both students and programs get the places they most indicated they prefer to be.  In pediatrics, 93% of medical students get one of their top 3 choices.  In my case, due to politics indicated above I hit #5, my deceptive failsafe.  It was a large program with all the clinical exposure I could want and a bunch of strangely unhappy pediatric residents.  In what should have been an exciting milestone in my career, I felt curiously numb.  I had a deep sense of foreboding. 

Whether this sense was prophetic or part of the problem, I don’t know, but I was in for the challenge of my life.

To be continued….

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