Dear Reader,
Thousands upon thousands of yesterdays ago man developed from what had once been nothing more than a single cell and even the face of the earth itself underwent a great many changes until the day finally came when I sat at my computer, nervously debating whether or not I should log in to the Office of Medical Education's website to view my Block One grades.
Part of my brain insisted that if I didn't look, the grades didn't exist and that really it would just be best if I continued on in ignorant bliss. The logical part of my brain reminded me that what's done is done and that the grades were there, within the website, and whether I looked or not, they existed and were not going to change. But still, I just couldn't bring myself to look.
And as I sat there with my fingers poised over my keyboard, my mind wandered away from the glowing screen before me and off to a memory of a recurrent dream which I have from time to time (generally when I am about to receive important exam scores or feedback on a story) and which I had had the night before. In the dream I am trapped somewhere way up high in a tower and, like dreamers often do, I somehow know that there is no way for me to escape from this tower and that no one is coming to rescue me. Not then, not that night, not even ever.
And the thought occurs to me that, if only I had long golden hair like Rapunzel, I could use it like a rope and throw it out through my window. And perhaps if it were heavy enough, it would pass through the earth itself and sink down and down and down and then snake it's way back up and out until it had found my rescuer. And because it was a dream he would somehow know to grab hold of it and he would follow it back and find me and free me.
But in this dream my hair is neither long nor golden nor capable of doing much of anything, and I know it cannot bring a prince to me or anyone for that matter. And yet in the dream I cannot help but stare out my one small window and dream of my rescuer's arrival. And so I wish and wonder and sigh and try to conjure him up. Try and try and try but still only nothing and nothingness. No knight in shining armor ever bursts through my door and takes me away with him. No, he stays wherever he is, where my hair might find him if this dream were more like a fairytale and not so horribly real. He stays where he is and nothing, not anything, will change that, I slowly begin to realize. Not then, not that night, not soon, and not even ever.
And so I wrench myself away from the window and sink to the ground at last, a mandolin appearing on my lap as things in dreams sometimes do. And as my hands--suddenly skilled in an art I have never attempted in the world of the waking--unleash a haunting melody, two liquid somethings slide down my face and make a plink-plonk on the strings which, much to my surprise, is followed immediately by a tap-tap on the door to my prison.
I move to the door at a speed only attainable in dreams, but as I reach for the doorknob I am overcome by a feeling of dread. It occurs to me that the person on the other side of the door might not be who I hope he is. He might not have come to save me but instead to harm me. And as I contemplate the risks and potential benefits of opening the door and learning who or what lies on the other side, my alarm clock erupts into life and I am suddenly myself again, lying in my bed on the morning of the day we are to learn our Block One grades.
After the memory ended and my mind drifted back to the present, I still was unable to bring myself to type in my username and password and can remember thinking to myself that if life were a fairytale, I would have nothing to worry about. In a fairytale land, every block two satisfactory grades would await me without fail. But just as in the dream, I was painfully aware of the fact that I did not live in a fairytale land and that it could be two unsatisfactories that I would find.
For a second I wondered if I closed my eyes and wished hard enough, that I might be able to wake up in my bed back in Atlanta, only to find that I was once again a freshman and all of med school to that point had been naught but a dream. But, knowing that that would never happen, I prepared myself for the worst, logged in to OME's website, clicked around until I found my grades, calmly shut my computer, and headed upstairs for lunch.
Now, before I tell you how I did, I feel I should say one thing: Even as I worked my way through the knowledge-based exam, I could tell that I hadn't studied correctly. I had mastered the basic concepts but hadn't learned any where near enough of the small details we ended up being tested over. When I finished my exam I knew it was going to be a close call, and so it came as no great surprise to me that, while I passed all the other sections with flying colors, I got a 61% on the KBE.
What did come as a surprise, though, was finding--upon reviewing my exam--that many of the questions that had been eliminated were questions I had answered correctly. After doing a quick calculation, I discovered that, including the eliminated questions, I had answered the same number of questions correctly as someone who had passed. And yet because of the particular set of questions I had answered correctly, I had failed.
Upon discovering that I was not the only person this had happened to, I decided to meet with one of the deans to discuss my/our predicament. And so that night I prepared my logic-based argument on why I (and the other students in my position) should receive a passing grade and why questions deleted should only be subtracted from the denominator of your score. I practiced and refined my argument with my mom. Practiced with my roommate who played the devil's advocate. Practiced writing it out. Even practiced one last time in anatomy lab.
But when I met with the dean, despite all my practice, my world came tumbling down. You see, the dean allowed me to work through my argument. She appreciated that I acknowledged the fact that I needed to change my study habits to avoid being so close to passing or failing that the questions chosen to be deleted could decide whether I received that S or U. She agreed with my argument that simply removing points from the denominator of each student's score would take into account the fact that different students were given different tips from different tutors and would even adjust for the fact that different questions do and do not make sense to different students because we all possess different reasoning skills. But in the end, while she agreed with my logic, she said that nothing was likely to change. The system they used had determined that I had failed while other students had passed and that was that.
Until that moment in the dean's office I suppose I had shut my eyes to the flaws in the medical education system because they had yet to effect me, but when the realization hit that the system was flawed and could have such a profound effect on me it literally took my breath away. And so it was that for the next twenty minutes I sat, crying a little, but mostly just hyperventilating in the the dean's office. And while I could not recognize it at the time, I later came to understand that what had upset me was not the fact that I had failed (in truth, I did much better than I had expected to do). No, what upset me was the fact that what had ultimately decided that I had failed while others who had answered the same number of questions correctly had passed was something out of my control. It was the harsh and unwanted realization that in a perfectly unflawed world, I would have passed as well but that I was living in a human world--full of flaws and bias--where others decided the rules and where there was nothing (or at least very little) I could do to change them.
After a long talk with my mom--a PhD psychologist who had also come to terms with the fact that graduate school operated on a biased and flawed system--I came to realize that, while it had been a highly unpleasant experience, it was probably for the best that I had had my eyes opened early on so that I could learn to navigate my way around such flaws in the future.
Towards the end of our talk my mom told me that medical school was going to be much like a heroic journey--full of monsters and obstacles that, at first glance, seem insurmountable. She reminded me that, at some point during their quest, all heroes fall and that the truly great ones are the ones who pick themselves back up, adapt, and continue on their journeys.
After we got off the phone, I came to the conclusion that failing the knowledge-based portion of my exam had been my first fall and that learning that the medical system is not perfect had revealed the first monster I would have to face again and again during my quest. But I knew I had learned from my mistakes and, more than that, had learned how to avoid future encounters with this particular monster. And I know this may sound cliche but I could feel that I was changing. My fall had been unpleasant to say the least, but in the end it had helped me to become stronger and even more determined to become a truly great doctor.
To close, I'd like to leave you with one of my favorite quotations:
"It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs; who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who, at the best, knows in the end the triumph of high achievement, and who, at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat." --Theodore Roosevelt
Until next time.
