I guess writing a reflection has become a yearly thing for me now. ¯\_(ツ)_/¯
Two months ago, I finished my second year of medical school, and at the beginning of this month I had taken my USMLE Step 1 exam, a medical board licensing exam that tests one’s pre-clinical knowledge. Basically a culmination of two years of med school.
This year also marks 10 years since my mom passed away. I made a trip to Chicago to visit her grave shortly after my exam.
For those unfamiliar with medicine, Step 1 has traditionally been considered the most important aspect of your residency application for specialty training, and to some extent influences which specialties you are “competitive” to apply into. This is changing in the coming years, as the exam has been changed to pass/fail starting 2022, but alas, I still took the test for a score.
This past academic year, I’ve had the privilege to learn about various medical diseases and their treatment. While Step 1 was a monster of an exam to study for (and I’ll spare you the details of the inner turmoil I experienced during my dedicated study period), it did lead me to reflect on what aspects of medicine I liked, and what I ultimately wanted from my career and life. These thoughts were also intermixed with reflections on the past 10 years of my life, and how much of it has been influenced by my mom passing away from ovarian cancer.
Before my mom’s diagnosis, I was never interested in medicine. I remember telling my dad in middle school I wanted to be an animator when I grew up because I loved art. He gave me a firm like hell I am going to let you do that.
But after my mom passed, medicine became a beacon of hope. I remember during some of my darkest days as a teenager grappling with the loss of a loved one (amongst other teenager emotions), the idea of impacting medicine gave me a future to fight for. To save lives. To not let other kids experience the loss of a parent.
My interests within medicine have changed over the past decade. At some point, I became intrigued with working with my hands in surgery. My undergrad bioengineering experience ignited an interest in medical technology. My experience working with underserved populations through Mobile Clinic Project and Outreach Van Project incited a passion to advocate for equity in medicine. I desired to work at an academic medical center.
The first few weeks of dedicated study time for Step 1 is hard for every med student. Your scores on practice exams will start far from where you want them to be, and it feels like all that you want to accomplish in medicine are locked behind this gate. Realistically, your Step score does not define the kind of physician you will be, but it is hard to separate yourself from this mindset in the midst of preparing for the exam.
It was during this time that I began to question if I could make it into academic medicine (which typically requires a high Step score) or the specialty I want to apply into. And in this episode of self-doubt, I began to ask myself, when did becoming a doctor no longer become enough? What happened to the teenager that just wanted to save lives?
Visiting my mom’s grave after my exam helped put things into perspective. It’s not that “simply” becoming a physician no longer excites me — but my understanding of medicine, its intricacies and limits, has changed, along with what I want out of my life at this point in time, rather than what motivated me 10 years ago.
Something that we use in medicine is a Kaplan-Meier curve, a graph that predicts mortality for a disease. 10 years is often the longest endpoint you would see on a curve. For ovarian cancer, because the prognosis is often bad, most studies do not publish a curve that exceed 5 years. When I think about my mother’s illness now, I often think of it in relation to this curve. How the current prognosis is so poor due to limited treatment options. And I could be the best physician I can ever be, and even if my patients had good outcomes, it would not make a statistical difference on that Kaplan-Meier curve.
This past year, I began to wonder, how can I make my impact on medicine? Status quo for current medical practice did not seem to be enough.
This is not to say that becoming a good clinician is obsolete. It is still very important to have well trained physicians who are able to provide individual, tailored care to their patients, and this is something I will continually strive to achieve in my lifetime. But I have also further acknowledged the importance of research within my career. Only with more research can we better understand the mechanism of diseases and engineer solutions to save lives and make macro-scale changes to a given Kaplan-Meier curve.
For this next academic year, I will be taking a break from medical school to pursue research in the treatment of vascular diseases. My classmates have begun their first rotations within the hospital this past week, a defining part of becoming a third year medical student. While a part of me craves to also be in the clinic and to progress towards my goal of becoming a clinician (I’ve admittedly felt a lot of FOMO seeing my classmates post Instagram stories of them in scrubs for their first day of clinic), I try to anchor myself to the understanding that my decision to take a year off for research ultimately aligns with my own goals to become an academic physician, one who balances clinical practice and research.
While I was in Chicago, one of my childhood friends told me I was too career-oriented. And admittedly, I just spent this whole post ranting about medicine. At the end of the day, we as humans continuously ask ourselves the age old question: what gives our life meaning? I think the answer is an assortment of things, and that it varies for each individual. There is no universal answer. For me specifically, the assortment of things that I find meaningful have changed over the 10 years since my mom has passed, and one piece of this pie is the idea of saving lives. At this point in time, my understanding of how to accomplish this involves clinical practice and research. And the pursuit of this goal makes all the steps leading to it —the rigor of medical school, the gruesome studying for Step 1, the year out of school to develop my skills as a researcher — worth it.
