Object Permanence

Last month, after reading Julia Levy's article about going on 30 first dates in the month before she turned 30, I decided that I also needed to set such a goal.  Mine: to have 30 first dates, or at least new introductions, in the next 10 months before I turn 30.  This is my way of dealing with the most recent breakup.  This is also my way to telling the world that I am fully open and willing to meet someone special (again). 

Really though, I'm scared of turning 30 single.  I'm even more scared of starting residency single.  What if I end up in a place without queer Jews to date?  When will I have time to meet people in residency?!  What if I meet someone living elsewhere, and neither of us can move until residency is over?  Who will support me through the hell of the transition into residency?  Who will be the first person I share my match results with?!  Anyhow, I digress.

One month into this mission and I'm at 2 of 30:
1. The first was an email introduction from a friend which has led to some nice conversation back and forth.  It is enjoyable but who knows when we'll ever actually meet face-to-face... Pointless?  Maybe.  But a least the emails are fun to write and read.
2. The second was a coffee date this morning with someone I met online.  She was lovely and conversation was easy, but, and it is a big BUT, I'm only here another week before embarking on 2 months of aways.  She's only here for the summer.  Is she worth changing my schedule around (sacrificing sleep) to try to see her again?  I don't think so.

Now I'm wondering if this is a futile mission all together.  My 4th year schedule has me pretty nomadic for the entirety of the year.  While I am not opposed to long distance relationships, long distance dating is a whole other creature.  An unconquerable beast.  How does one date and start a more serious relationship when they don't have any stability to their life and everything is a big unknown?  Knowing what my schedule looks like, and how people react when I talk about my plans for the year, I can't imagine there is any possibility that I won't still be single a year from now.

Goal: stay up right, don't get hurt

The charity bike ride is this weekend.  It will be the biggest physical challenge I think I’ve ever attempted.  That is assuming that I ride more than 20 miles.  Therefore, I’m terrified.  I am so touched that my friends and family have donated so much money to support me, which I interpret to be either because they believe I can do it or they are in shock that I’m even trying. 
 

Seeing as I was basically a non-bike rider at the start of this (not learning to ride a bike until I was 19, never having ridden more than 2 or 3 miles at a time, and not having been on a bike in 3 or 4 years) I have 2 main goals:

1)      Stay on my bike

2)      Don’t get hurt

Actually, as long as I don’t get hurt, I’m not really sure staying on my bike is even that important.  The full ride is either 80 miles or a 120 depending on the course you choose.  My housemates are all doing the shorter 80 mile option and so that’s what I’m planning on too.  Even if I only make it one day, 40 miles, that will still be a new achievement for me.  Need to focus on small victories and not be disappointed when I don’t complete all 120 miles… that can be next time, right?

I just want to have fun.  Really, I want to not be anxious about this ride and to have fun.  Sun, endorphins, friendship & comradely, a post-ride massage scheduled – this really could be fun! 

What a difference 4 years makes

Election night 2008 is a vivid night in my memory.  I arrived back at my house around 6 or 7pm from 2 long days of medical school interviews to find a house full of friends watching the TV and an envelope from a school I had recently interviewed at.  I opened my first acceptance letter surrounded by the love of my community and with the optimism of change in the air.  The night was spent intensely watching returns, having both light hearted & deep conversations, coloring in maps, and day dreaming about what the future would hold.  I went to sleep with the certainty of Obama’s victory and my long awaited admissions ticket to medical school in the fall. 

[However, learning about the prop 8 results when I woke the next morning was heartbreaking and felt like a personal attack.  And now, 4 years later, we’re still trying to untangle the mess it created.  Hopefully, tonight’s vote on marriage have an opposite outcome as prop 8 did.]

4 years later, I am wrapping up medical school.  I would be on the interview trail again right now had I not elected to take this year for research.  I am anxiously awaiting the news tonight will bring in a new city with a new community.  I am uncertain about my future – about what our healthcare system will look like tomorrow and how it will affect my career.  While the economy is likely to continue to improve (assuming we don’t start another war), healthcare, women’s reproductive rights, and queer communities in the United States are resting on a precarious ledge. I pray that I go to bed tonight with the same optimism and certainty that I did 4 years ago. 

Surprising twist

In a surprising turn of events, all of my allergy skin testing yesterday was negative. I was negative for all 69 triggers that they tested. The doctor was baffled and I was [pleasantly] shocked. My clinical picture very much pointed towards allergies being the culprit for a lot of my generalized 'yuck'. That said, after some pulmonary function tests and a significant improvement post administration of albuterol, I was given the [equally] surprising diagnosis of "asthma / an asthma spectrum breathing issue" and a 1 months sample of asthma management drugs to see if there is any improvement.

The doctor also discussed emerging research supporting local IgE response in both the nasal tract and gastric mucosa- which would mean that one is actually allergic to something but that there is no way to easily test for it as there will be no response to skin or blood testing. Local IgE?! This challenges everything I learned in immunology... given immunology was the pre-clinical class I struggked most with.  However, reviewing some scholarly articles on the subject today proves him right, that this is an emerging belief in the allergy and immunology world. They have no way to test for these triggers and so I may never know if this is in fact what is going on with me. Maybe I actually am allergic to something(s) (which I suspect to include dust and mold) or maybe I'm just a paranoid hypochondriac? 

Babies!

It seems that all of my non-medical school friends are having babies!  [And since the girlfriend is sick of hearing about which friend just adopted and which just announced she's pregnant again, I'm sharing the news with you, dear blog-reader.]  I'm so excited for all my friends!  I'm also excited that there are lots of little babies I get to knit for, dress up, play with, take on adventures, and give back when I get overwhelmed.

Yet, at the same time, I can't help but feel my biological clock tic away while med school keeps on keeping on.  Tic. Tic. Tic.  I know, I know, it is so cliché.  Fears of approaching advanced maternal age while still being in residency are so yesterday.  My attending already called out this week for making a snarky comment in the OR regarding man's ability to father a child well into his AARP days....  Yet, as much as this bridge has been crossed by most other professional women that have come before me, I can't help but feel my uterus scream out in disdain as I draw ever-closer to the big 3-0.  

On the bright-side, lots of friends having babies now means I should have lots of readily available babysitters when [if] my turn ever roles around? Right?

Confession (how I'm spending the summer)

I'm currently studying for step 1. Again. For those of who don't know, the only way one repeats a USMLE step exam again is by failing... so, yes, I failed step 1 my first time taking it in April. All be it, I failed by a very slim margin, but failed none the less. I very aggressively debated the shame vs. potential merits of writing this post, of making my failure so public, settling on the decision that this may help another med student in my position and/or someone out there might have advice for me.

I'm now officially part of the approximately 5% of US medical students who fail the stinking 300 question test of annoying detail. From what I can gather, here is the normal response to failing: 0) Consider dropping out of medical school before reconsidering when calculating the debt already stacked up. 1) Only tell those who NEED to know but hide it from the rest of the world. 2) Cycle through the Kubler-Ross Grief cycle over and over again. 3) Fixate on how this might influence your future: will I be able to match into a residency program? will I match in bumbleville, nowhere in a specialty I don't actually want to be in? what if I never pass this f*ing test? 4) Spend a lot of time, energy, and money reapplying and scheduling the exam, reorganizing your 3rd year clinical rotations, deciding on a study schedule, and motivating to do it all again.

I'm sure this comes as no surprise to anyone, but I'm not normal. I've slowly told those around me in hopes of ensuring that my support system will be well established for this go around. I've also pretty much settled into the stages of anger, more anger, and some acceptance. I'm working on the emotional aspect though, just as I'm working on relearning all the nit picky details about biochemistry and anatomy. I've come back to my parents' house to study this time so that I can limit my distractions, am using a slightly different study strategies, and am integrating context from the medicine clerkship into facts I learned over the first 2 years of med school. I'm trying but it just kind of sucks. I miss my girlfriend, and feel guilty that I'm not around to support her through BAR studying like originally planned. I miss my cat. I'm bummed that I had to pull out of my next clinical rotation. I feel guilty that I had to pull out of speaking at a conference next month in order to keep studying.... and so much more.

However, there is a silver lining to everything right?
-I traded in the awful Southern summer heat and humidity for much milder temperatures
-An opportunity to reacquaint myself with a home, and extended family, I haven't spent much time in since graduating from high school 9 years ago.
-A second pass at all of this info may/will prepare me even more for the pimping to come over the next few years
-An opportunity to increase my score from just passing to much higher (G!d willing!)
-Motivation to apply for year-long research fellowships that could help boost my CV
-After telling my medicine attending, having her strongly respond with: "you must be a really bad test taker because you clearly know your medicine!"
-A solid reminder that I'm in the minority and therefor special. We all need that every now and again, right? (Okay, so this one may be a stretch)

But overall, 3 days in to restudying, the situation just sucks. Oh well. What other option do I have than to pick myself up and keep trekking forward?

Posts will be few and far between as I fall deeper and deeper into the land of step studying but, assuming I can find my way out, I will eventually return.

High school flashback

A friend shared this YouTube video with me today. While I deeply wish that we lived in a world where these types of speeches didn't have to happen, I'm am so inspired to know that there are youth out there like her. This young woman, Kayla, is articulate, passionate, and heart-breaking to watch. I have no doubt that (if she chooses to) she will help to change the world. Her struggle with self-realization, discovering of community, fear of future, and desire to love freely is something that strongly resonates with me. I went through a similar process in high school before ending up in a position much like her: being an outspoken advocate to my peers and the larger community through sharing my personal story. Even still, as much as I've grown into my self over the past 8 years, I still struggle with some of these factors.

Watching the video inspired me to pull out my old high school journal. While there are many pieces of writing touching on my evolving sense of sexual identity, there is one particular piece that strikes a nerve for me. It so strongly reminds me of who I was at 16 along with my fears at the time. It gives perspective on how far I've come, and also kind of excites me to see what changes the future bring.

Written at 16 (in Fall 2000):
"To be scared of the truth, that is only normal right? But what if the truth can change things? What if it changes the way people see you? The words that people use to describe you? What if it changes how people look at you? Or how they touch you? And does it really change things this much, or something you just fear. What if your initial instinct is wrong, and after all the trouble you are only 'normal'?

You see, it has been a big summer for me. A summer of self discovery and of experimenting. A summer of pushing the limits I had already set up for myself and of testing new unguided territories. But the summer has quickly ended leaving me uncertain and in new worlds. For the first time in my life I have a girlfriend when all I have ever imagined were boys. I'm now explaining to trusting friends that I am Gay, something that I'm not even sure of for myself. They all react the same way though; they all told me that they already knew, which only leads me to question myself more.

But summer has ended, and to go back to my old ways of life isn't as easy as I had hoped. What if people know? Will it change the way they see me? I'm used to hugging my friends and kissing them on the cheeks, will that stop? Would the people I'm used to cuddling with at [youth group] events be scared away if they knew the truth? It scares me, why wouldn't it scare them?

I know [youth group] is supposed to be a safe and accepting environment but when people use terminology like 'oh, that is so gay' and when they address people as 'fags' for being outcasts, how am I supposed to know what affect it would have on the way I am treated. And what happens when everyone is either hooking up or talking about their relationships at home, am I supposed to say 'yeah, I have a girlfriend' and well, come out of the closet to people I don't know so well when I'm not even sure if I'm in the closet?

But like everything else time will tell. The event will come and go and people will probably never find out. I'll hug and cuddle and just wonder what they would think if they knew the truth, and I will wrestle with the thought of being Gay in my own mind. In the end I will fall in love with the person I fall in love with, not with the sex of the person, and feel foolish because I pus so much time into trying to put labels to feelings that shouldn't always be defined."

Modern love

Quoted from Nicole Hardy in the article "Single, Female, Mormon, Alone" (The New York Times, Modern Love, Jan 7, 2011):
"Perhaps the failure was mine — I’m sure many church members see it that way. I was too weak to endure. They’ll say I should have waited another decade, or spent my whole life alone if that’s what God required.

I’m just unwilling to believe that’s what God wants for anyone, and was unwilling to continue spiraling further into a disconnected life, feeling abandoned, being discounted."

I couldn't agree more. While I don't really believe in a G!d that is so intertwined in our daily lives, if G!d is actually involved in our match making, I can not fathom s/he would want anyone to be single (who doesn't want to be). As much as I accomplish in my life, I can't help but feel my life is still completely unfulfilled because I haven't found my basherit. I'm nearing 27 and am seeming to be eternally single. I'm trying to make the most out of my life: being a family member, a friend, an activist, a community member, a (future) healer; trying my hardest to be content with my lot. But, I can not help but wonder if I'm destined to spend my life single... and if I do spend my life single, what will that mean for my standing in the religious community? A community that is totally built on family life and procreation. I need to put these thoughts on hold for now though as I go back to studying for tomorrow morning's exam!

Here is a little secret: we're all going to die

I don't think that by stating this inevitable fact I'm bringing on the grim reaper or evil eye, but just in case: poo poo poo. I don't mean to be morbid. I also don't mean that we're all going to die NOW. What I mean is quiet simple: sooner or later, each in our own time, our lives will end in death. After all, did we not learn anything from Disney's "The Lion King" about the circle of life?

My week in London was surrounded by Jews and learning. I was at a 6 day conference with over 2200 people and >400 sessions to choose from. It was kind of like summer camp for grown-ups, expect on steroids. We woke up early to pray and learn, kept our noses in text all day, and then chatted, sung, and danced late into the night.

Many of the sessions I attended related to medical ethics. I went to one on Talmudic tips for breast feeding (one should breast feed up until age 2, tsniout is not an issue), another on sexuality outside of marriage (the realization that humans are inherently sexual), another on what the torah has to say on resource allocation in socialist health care (we are obligated to save lives), another on whose life are you obligated to save (2 people, 1 water bottle...), etc...

However, the sessions on halakhic organ donation, on brain death vs. heart death, and on assisted dying are the ones I feel compelled to talk about here. The common theme in these sessions, and something that I see often in medical school, is that our culture is afraid of death. We're afraid to think about it and talk about; as if doing so will make it happen to us. Doctors seem to be the worst at this: often scared to admit that we can't save all our patients from their inevitable death. However, this fear isn't helping anyone. It means that rumors and superstition are allowed to spread rampant, loved ones are left to make choices without guidance, and that end of life care is much more invasive and costly than is necessary.

I believe this all can be changed with a few simple steps. I urge you to consider doing 1 or all of the following:
1) Think about becoming an organ donor. Get the truth on Judaism and organ donation. We don't want to think about dying young or about someone taking out parts of us; but remember that saving a life is the BIGGEST mitzvah one could do. Also, that livers have been donated from people in their 90s! Signing up to be a donor doesn't mean your destined to become one; if this were the case, there wouldn't be an organ shortage.
2) Talk to your family and friends. Let them know how you feel about end of life care and about what you decisions you hope they would make for you. Have these conversations often and under the auspice that our choices will evolve as our lives evolve. By having these conversations, you'll save your loved lots of grief and confusion; allowing them to know their living out your will.
3) Create a living will. Assign a medical power of aterny/health proxy. Use the legal framework in your favor to know that your wishes will be upheld in the event that you are unable to make the decisions yourself.

pitty me, I'm a medical student

I'm currently having a bit of a pity party. Tonight there is a rather large benefit concert at a local bar, a holiday party with my Jewish community, and a bar take-over with the city's queer community.... yet it is not even 10pm and I am sitting on my couch with Lulav, watching TV.

It isn't that I'm totally unsocial, I just can't seem to handle big group gatherings. Last night I hung out with a classmate instead of going to an upperclassman's holiday party. I then spent all of today studying. Right after shabbat ended, I met up with a classmate to get manicures and then grab dinner at a local thai restaurant. Tomorrow will also be spent studying, followed by an abortion movie screening and dinner with another friend.

The self pity stems from frustration in lack of a work-life balance. Also in the realization that this balancing act will never get easier. I can tell myself that life will ease up post-step 1, or post-3rd year rotations, or post-internship year, or post-residency, or post-fellowship, or, or, or... I simply wonder if medical school is causing me to be less of an extrovert. Instead, turning me into an unsocial, exhausted, isolated, single minded, socially awkward monster. If I can't rally myself to hang out in the bigger world now, how am I going to maintain a large (and non-medically based) social community? How am I going to have conversations about real world topics? Or worse, how am ever going to meet people to date?

Conclusion: my pity parties always seem to fast track me to crazy cat lady status.

Where is the line?

I've been thinking and talking a lot about abortion today. Day dreaming about women's reproductive health isn't totally uncommon for me, but because of the Med Students for Choice national conference I was at this weekend, it is especially on my mind. The conference was such a high. A total reminder of why I was drawn to medicine in the first place, what I hope to accomplish in my career, and that there is a world of like minded peers out there (even if I am separated from the majority of them by the Mason-Dixon line).

I have so much I want to tell you about the conference. I took notes during the workshops which include many ideas for blog posts scribbled in the margins. These posts will (hopefully) come in due time. Once I have finished processing, caught up on sleep, and no longer feel like I am drowning in renal pathology. Okay, okay, maybe I wont wait that long; but I am not yet ready to post about it all tonight.

In the meantime, I received a gchat message from a classmate today. A classmate that is very much a friend. This was the message: "http://www.makearightchoice.com/index.htm
that's an interesting website i found in my research. thought you might want to take a look. "

I can't tell what his intentions were for sharing with this me. Was this in response to my attending the conference? Or did he really just want to bring it to my attention that such websites exist? I am (pretty) sure he didn't mean it to be threatening or an intervention, but regardless of the intentions, it still stung a little. This is someone who I deeply respect, conservative views and all. We dialogue about our opinions, we agree to disagree, and we normally are very respectful of the other's perspective and ideology when interacting. However, intentional or subconscious, I feel that this crosses a line. This plays into my fears about the path that I am on. Regardless of my fear of overt or subtle harassment, I WILL NOT stop being an advocate for abortion and I WILL continue on my path to becoming a provider.

"Can I Physically Do This?"

I am spending my summer doing research on adolescents with lifelong, and function limiting, chronic illness. Spending hours pouring over qualitative data on how teens identify with their illness has reminded me of my relationship with diabetes as I transitioned through adolescents. It also reminded me of the summers I worked at diabetes camp, and my tween and teenage campers who I desperately wanted to grab by the shoulders, look in the eye, and promise that it would get better in a way that they could hear.

Today, in hopes of nurturing my professional development, my PI (principle investigator) spoke wise words about my academic future: "You are in a tunnel. There is an end. But at this point you need to be careful that the light you see isn't another train coming at you." These same words so adequately describe the double edged sword of being a teenager and having a chronic illness.

Even now, a few years removed from the turmoil of teenage insecurity, I still struggle with acceptance of future: as a physician, as an adult giving back to society, as a sister, daughter, wife (maybe?), mother (hopefully), AND as a type 1 diabetic. Below is a "fear essay" on the subject that I had to write for our humanism in medicine class this past fall:

Can I Physically Do This?
My biggest fear about becoming a physician is actually less about the process of becoming one and more about my future career in medicine. I am afraid of not being able to physically handle the life-style associated with the practice of medicine. I am also afraid that the stress associated with a life in medicine will have a negative influence on my health. I am afraid of there being truth in all of the nay saying I have heard over the past 19 (plus) years of living with type 1 diabetes.
At six years old I was diagnosed with diabetes after an abnormal result was found on a routine blood glucose test during my annual physical. My blood sugar was 157 and I was completely asymptomatic. Three days later my pediatrician performed a very unscientific glucose tolerance test (checked my blood sugar, sent me out to eat a sugary breakfast, had me come back to check my blood sugar again). This led to me being ushered off to the pediatric endocrinology unit at the local teaching hospital. The events of that day are my first tangible and complete memory.
Growing up with a chronic illness, especially one that is surrounded by a huge amount of misinformation, has been hugely influential in the development of my personality. I believe that my experience as a “diseased” person in society is what led me to major in Medical Anthropology, a background that will be hugely beneficial to my career in medicine. With no one in my family in the medical field, I strongly believe it is also what inspired me to seek a career practicing medicine. This desire was strengthened when I was diagnosed with Celiac disease after many years of seemingly unrelated symptoms. Diabetes has given me a (sometimes overzealous) drive to achieve everything I possibly can and not take a single day for granted.
However, there have been tremendous physical and emotional obstacles to surmount. One of the greatest challenges for me has been overcoming the emotional burden of the “scare tactics” used on me as a child. I grew up in the age of “if you eat that your arm will be amputated”, “if you don’t check your sugars more often, you’ll loose your eye sight”, and “high blood sugars will kill you”. I was taught to weigh my food, to micromanage my sugars, to be meticulous about taking insulin, and to use food exchanges as a way of cheating death. My parents, doing the best they knew how, had the attitude of “everyone has their problems and so at least you know what yours is” which left little room for me to ever be upset or frustrated at the disease that shared my childhood.
I made the decision to pursue a career in medicine a little later then most of my peers, as I had to first determine that diabetes was not going to get in my way. While I rationally know that it wont, and know that it never has before, I am still fearful that it will. There are many events that have happened recently to reaffirm my fear of a future as a diabetic in medicine. Such as my endocrinologist advising me to keep my disease hidden in the application process and in medical school rotations, as according to him, “old world surgeon types will judge you and think you are incapable”. Or having to fight to be able to take my insulin pump and blood glucose meter into the testing room with me during the MCATs. Or that countless numbers of people have given me unsolicited advice about how as a diabetic I should avoid high stress lifestyles in order to avoid complications.
I find myself wondering how I will manage to keep my blood sugars stable during the unpredictable pace of 3rd and 4th year rotations. How will I carry my pump, multiple pagers, and a smart phone on scrub bottoms without them falling down? (I have mastered the pump and 1 pager or radio already, but not multiple.) I worry that I wont be able to fit exercising, sleep, and cooking healthy meals into the packed life style ahead of me. I am concerned that high levels of stress combined with little sleep will lead to uncontrolled blood sugars. And I worry about what will happen if I have a sudden low blood sugar, or accidentally pull out my pump site, while working a code or during surgery? Will diabetes hold me back from a specialty I really want to pursue?
I also find myself worried about diabetic complications, and irreversible past damage I may have already done to my body. If I loose a limb as a result of this disease, will that be the end of my career? And if so, why am I putting all of this time into trying to be a doctor in the first place? Should I be taking advantage of the time I have with all my appendages somewhere else? Or what happens if I go blind?
I also worry about how my experiences with a chronic disease will influence my ability to doctor, and how I view my patients. I already know that I have an unfair frustration towards type II diabetes and diabetics due to the assumptions made about me from the mention of “diabetes”. I need to quickly get over this bias, as I will probably have many type II diabetic patients regardless of my specialty choice. Will I be unsympathetic or judging of non-compliant patients? I really hope not.
I know that I am not the first diabetic to pursue a career in medicine and I am sure I will not be the last. I also know that I have had the blessing to grow up surrounded by new technology and that things like constant glucose monitoring systems will significantly ease the burden of managing diabetes in a fast paced life style. I also realize that it is okay for me to have these fears but I need to ensure that the fear does not become debilitating. Hopefully my diabetes will aid me in my career as the best physician I can possibly be instead of holding me back.

Don’t drink the Kool-Aid

This summer, what is likely my last real summer, I am working as a research fellow in an elite hospital nestled in a North Eastern City that used to be my home. In fact, it is one of the world’s best hospitals, something we are often reminded of. While talking to a first year fellow last week, I was strongly warned not to “drink the kool-aid”. She, a newly minted physician activist, spoke of coercion and loss of ideals. She warned of the magical allure that these old white men have, drawing the vulnerable young idyllic doctors in with promises of prestige. She has a compelling point, but at the same time she seems to be making it work.

Plus, I am learning this summer how tasty the kool-aid is. I have come to terms with the idea that I am smart and capable. But, while smart enough, I have never been THE best or THE brightest, instead always having to settle for my second or third choice. Such was the case with my college selection, with my post college employment, and with medical school. While I loved my college experience, and I am content with my medical school, this was never the path I envisioned myself on. Being at the best hospital this summer in a relatively elite fellowship is giving me a glimpse at the power and freedom that comes from it all. Because they are the best, they are able to talk about taboo topics: sexuality, psychosocial complications in delivering health care, medical standards; and, shockingly, can even conduct research in these uncharted lands. This is not something we can readily do in my southern medical school, where instead we are instructed to not tremble the waters. What I am learning is that the kool-aid gives you a pass to the unknown, but with it comes a signed contract: no matter what, the institution, one of the world’s best institutions, needs to be kept on its pedestal.

The other problem with the kool-aid is it leaves you thirty, and unable to settle for anything less than kool-aid of equal caliber or better. But the better kool-aid is going to cost you more of your ideals and personal autonomy for the sake of protecting the institution. The point of all this kool-aid talk? I am in limbo between loving the reality I am experiencing this summer and being terrified about my future. I want more of this opportunity- more ability to do research at a hospital with countless resources and copious respect. I want to apply for a fogurty or a doris duke fellowship so that I can accumulate prestige to compensate for my decently (but not overly) adequate Southern medical school’s reputation. I also want to be smart enough so that I can work and live in this, or a similar, North Eastern City that used to be my home. The terrified? That comes from feeling insecure by the elite that surrounds me. From worrying that I will never be smart enough for this to be my life, and that again I will have to settle for second or third best instead. That before this summer even ends, they will discover that I shouldn’t even be here now. Even worse, I fear what will happen if second and third best aren’t even options when it comes time for residency matching? What if all this work is for naught, after sacrificing so much, I never become the physician activist I so hope to be? But on a third hand (which anatomically we don't have), I am also learning that sometimes going with the less prestigious option allows for a better fit and more flexibility to be a change-agent, and less hurdles to jump through... a lesson I assume will be important to remember over the coming years.