"The brick walls are there for a reason"

I was not the perfect applicant. I am an old international medical graduate, 5 years to be exact. Although I performed very well in medical school, my step scores were left to be desired. I took my step 1 back in 2013, right after passing the medical boards in my home country. My over-confidence became my kryptonite. I failed step 1. To say that was a deathly blow to my ego is an understatement. I did not let that deter me, however. I decided to work as a general practitioner to expand my clinical experience and knowledge by dealing with actual patients. By the end of 2013, I moved to the United States. The sting of failing step 1 never left me, and it brought another emotion with it that sort of crippled me - fear. Fear of facing it again; fear of re-taking it with the possibility of failing; fear of the countless inevitable. It was probably due to that fear that prompted me to take CS and step 2 CK first before tackling step 1 again. I passed both without difficulty.

After passing both steps, I decided to start doing clinical rotations and observerships, and at the same time, study for step 1. I spent more than 6 months rotating in both Internal Medicine and Psychiatry. I figured these rotations would not only help me in preparing for step 1, but would also expose me to the medical health system here in the United States. Nothing could have ever prepared me from the devastating news I would later receive while I was in my Psychiatry rotation - I failed the second time. I failed by 2 measly points, but a failure is still a failure. I was beyond crushed. That failure hit me hard because I was not expecting it at all. Expectation did not meet reality, and that was intensely difficult to bear. I remember crying to my husband on the phone. He asked me, "Well, what are you going to do about it?" I said, without hesitation, "I will take it again. Nothing is going to stop me from achieving this dream."

Instead of bringing me down, all these setbacks actually inspired me to do do better. I love the field of Psychiatry more than anything. I knew what I had to do. I studied again for the third time. This time, I did not do any outside rotations, nor did I let any distractions affect me. Finally, I passed step 1, and was able to receive my ECFMG certificate by August 2016, just one month away from the date of application. By September 15, 2016, I applied to more than a hundred Psychiatry programs all around the country. Because of my step 1 history, I knew I was going to have a difficult time getting interviews. I was just hoping that at least one program would choose to look beyond my step 1 score, and look at other parts of my application. One month later, I received yet another catastrophic news. My eldest sister died. At that point in time, I felt like my world was crumbling around me. Was I devastated? Absolutely. Did I feel hopeless? Absolutely not. You see, I have my parents to thank for raising us in such a proper, loving, and God-fearing environment. Despite everything that has happened to me, I know that everything is going to be okay. Sometimes, things just don't happen the way we want them to. Oftentimes, alternative events have to happen first so that we can get what we want.

By the end of October, I was still not getting any interviews. I started calling and sending letters of intent to all my programs. I reached out to people, strangers even, who might be able to help me get an invitation. I will never forget that one, fateful day, when I randomly saw a beautiful, inspiring message on Facebook, posted by a doctor. I did not know who he was, but something prompted me to click on his profile and browse through some of his photos. His photos tugged at my heartstrings, mainly because I saw how close he was to his family. It reminded me of my own family, and the intense sadness I have been feeling (and trying hard to suppress) because of my sister's passing, came rushing in. Without hesitation, I messaged this doctor and poured my heart out. I told him about my steps, my sister, and my deep passion for Psychiatry. I thanked him for his inspiring and uplifting posts. I remember telling him that I am willing to undergo several Matching cycles until I make it. What are the odds, that this doctor turned out to be a Psychiatry resident? After exchanging several messages about my credentials and US Clinical Experience (USCE), he told me to apply to his program and he will see what he can do. By the fist week of November, I got my very first invitation from his program. I was ecstatic. I could not believe how one random profile click on Facebook lead to this. I really believe that sometimes, the universe conspires to help you get what you want.

By the end of November, I received a call from the program coordinator of one hospital I applied to. She read my letter of intent and showed it to the program director. The program director liked my application, and she wanted to invite me for an interview. I was so happy. Things were finally looking up! I could not stress enough how important it is to reach out and follow up with your programs. Send emails of intent, and call the program coordinators if you have to. Do what you have to do to get them to notice your application. My husband who matched last year in Internal Medicine got 3 more invitations because he was able to impress the program coordinators when he called to follow up his application. Sure, there is that probability that some will get annoyed or ignore you. But you know what, it does not matter. At least you have done your part. You have nothing to lose, and everything to gain. Trust me on this. 

In our profession (or any profession for that matter), friends matter a lot. I know a lot of people who, during the application season, become hermits and seem to just disappear from the face of the earth. Then, when match day arrives and they match, they will suddenly spring back to life, announcing the wonderful news in every form of social media. Please, do not be like this. Respond to people, whether in need or not. Reach out to your friends and colleagues, especially those already in a residency program. By the first week of December, I received my third invitation from a Psychiatry program in New York. I later found out that one of my friends in Internal Medicine from that hospital talked to the program coordinator of Psychiatry. He also made a recommendation letter for me and gave it to the program director of that program. I was overjoyed and truly grateful. Friends like that don't come everyday. He went through such great lengths for me, and the only way for me to repay that favor is to pay it forward. Remember, we are all in the same boat. When you have the capacity to do so, help others in need. Never forget to look back where you came from.

As December was nearing to an end, I received my last invitation. This is the program I would spend the next 4 years of my life as a Psychiatry resident-in training. I had a feeling I would match here after my interview with the program director. He told me, right there and then, that he would really love for me to be a part of that program. I know there are lots of stories where program directors would tell the applicants that they are a great match for their program, but they would not end up matching at all. I don't know why, and I can't seem to explain it, but this one is different. It felt different. I remember telling the program director how grateful I am for him to choose me as an applicant despite my step 1 scores. I specifically told him, "thank you for choosing to look beyond my scores, and for giving me a chance to show you that I am more than what my scores tell me." He told me that during the course of our interview, he immediately knew how much I really love Psychiatry. I was able to show him how passionate I am about my field, that he chose to believe the person in front of him, instead of what he sees on paper. Your step scores matter, yes, but they do not, in any way, define you. Once you get invited for an interview, you and the other applicants are all on the same playing field. Make sure that you come in prepared, because that one interview can make or break you. You have to make your drive and passion felt. Stand out. Be remembered.

This entire USMLE experience has been such a humbling experience for me. It taught me how to deal with failures, setbacks and disappointments. It actually made me realize that I am so much stronger than what I give myself credit for, and that my failures do not in any way define me, but how I move forward will. Besides, these moments that challenge us yield the greatest opportunities for reflection and growth. This journey has never been, and will never be easy. In my opinion, it should not be, since we are dealing with precious lives. However, it is not impossible. As Randy Pausch said in The Last Lecture, "The brick walls are there for a reason. The brick walls are not there to keep us out. The brick walls are there to give us a chance to show how badly we want something. Because the brick walls are there to stop the people who don't want it badly enough."

You can do anything, and be anyone you want to be, as long as you set your heart and mind to it. Reach out to people. Ask for help. Once you are in the position to do so, return the favor and help others. Be grateful, gracious, and kind, not because you need something in return, but because you really mean it. Get out of your comfort zone. It might surprise you what you are capable of achieving. Sometimes. you will fail and fall down. Who doesn't? Stand up with your head high and try again. These bumps on the road are there for our own good. They build strength and character. Never give up. If I can do it, so can you.