Once a medical student has graduated from medical school, he/she has earned the title of "Doctor". They are required to complete only one more year of training, once referred to as an internship (generally the first year of the residency) and completing the third part of the Medical Boards to get a license and practice medicine independently. Nowadays, medicine is much more advanced and one year of an internship is not truly considered adequate training for a person to be a solid physician but legally a person could do this. To be able to practice in one's chosen field and expect to be able to bill an insurance company, one needs to complete a complete residency. Ideally one should become board certified in that area, although this is not always necessary. (One of the reasons they warn people to be so selective about plastic surgeons is that loophole that allows physicians to practice without being board certified or board eligible.)
On "Match Day" every 4th year medical student in the country is given a letter informing them of where they will be doing their residency. During the 4th year, a good amount of time has been spent applying for, and interviewing for residencies. A very complex computer system that matches up the students' preference list with the residency programs' preference list and assigns students to residency programs. This is announced in a big party with a great deal of fanfare where each student goes in front of the class, opens up their envelope and reads where where he or she will be going and in what field. Then they cry and give a speech where they thank their mother and father for bringing them into this world and comment on their friend's Chanel Couture gown and Mariah Carey performs, and...
OK, I made that part up, but there is a lot of celebrating and balloons and banners. People cheer and the few that got stuck in some "transitional year" because they did not match anywhere they wanted try to hide their disappointment. One hopes this does not happen too much, but there are always a few. And there is a keg in the student lounge. No, I am not making that up. Some lucky people even have beers in their mailboxes. After four years of hell they figure these guys have earned it.
That is is beginning of the end. Those last few months, rotations are more lax because the students are making preparations to move, obtain limited licenses in some cases, and filling out A LOT of paperwork. They have their residency assignment so all they need to do is pass, not well, just pass. They are about to earn that long coat and no one is looking back.
And neither did I. I survived the end of the year and graduated. I recieved my four foot long hood, the most coveted of all hoods signifying I had a doctorate degree. I was a doctor now. No one could tell me that I was not smart enough, did not try hard enough or did not have what it took. No one could tell me that I was not allowed to be a doctor, that I needed to be a nurse or needed to know my place in life. I realized that it is true when they say that people can only put limitations on a person if one lets them. This time, I did not let them.
Not that residency was easy. Residency was tough. Taking call is brutal, but psychiatry is often referred to as a "lifestyle specialty" because it is not so abusive and exhausting. Nothing like internal medicine or surgery. And it was what I wanted to do.
As far as changing, I probably changed in those four years more than in medical school. Working with patients who often do not like you for no reason except that you remind them of their mother takes a lot of strength. Learning to cope with verbal abuse, threats, and statements that at times can be downright cruel can be hard to do, but if one cannot learn to do this, one cannot expect to survive in psychiatry. They will be uttered by some patients with reckless abandon. Some will be too psychotic to be able to give a history at all. Some will be violent and require a great deal of caution. I have been assaulted by a patient once, largely unprovoked and I know that it was not her illness that caused it. She was just sociopathic. They will push your buttons, insult you and refuse to cooperate. They will do just about anything they can to get you angry, and sometimes they will. They will hurt your feelings, call you stupid, incompetent, ugly and a litany of expletives that I will refrain from listing. If you let it bother you, you will not survive in psychiatry. It took a lot of changing to learn to feel good about myself and be able to endure this kind of treatment.
Ultimately, my journey through college, graduate school, medical school and residency took me 14 1/2 years to complete. Although I passed Part III of the Medical Board one year into residency and was able to become an independently licensed physician after that, it took me several years after completing my residency to finally complete the process of becoming Board Certified as a psychiatrist, which is the usual process.
Despite anyone who doubted me at some time in my life, I DID catch my dream. It took a lot of soul searching, tearful nights, pep talks by supportive friends and roommates to get there, but I did it. I had a great deal of my own self doubt to overcome and it took years of counselling to work through this and to find the strength to pull through. Many would have viewed the detour that I took through graduate school as a waste of time, but I realized that I was simply not emotionally ready to enter medical school right out of college and had I tried, I very likely would have failed. I left graduate school on good terms with a much higher GPA than I had in undergraduate school which certainly did not hurt in getting me into a more respected medical school either. I feel good about the things I have achieved in these years because I know that I was the one who did it. Maybe I made mistakes, but I fixed them. No one else was left to clean it up. And I did by myself. I am proud of that fact.
So why do I keep a dream catcher hanging over my rear view mirror? The old native American tale was that grandmothers would hang them over their grandchildrens' beds to catch the bad dreams and protect them from their grandchildren. For me it is the opposite. My dreamcatcher is a reminder that I had a dream, I struggled for years to get it, and I caught it. It is a reminder that I can achieve my goals if I really want them. It is a reminder to never give up hope, to appreciate my blessings in life, but to never give up on those things I aspire to.
Never give up on your dreams.
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