I finished my Internal Medicine Residency in summer 2020.
I was compromised with my studies and doing the best that I could in order to prepare myself for the American Board of Internal Medicine (ABIM).
My program took this test very seriously. As it should.
I did the work, put in the hours for the senior meetings that were mandatory and included workshops from the ACP.
I did my MKSAP 2017 & 2018 in full, at least 3 times total.
I spent most of my free time doing questions and reading like a lunatic.
From January to May 2020, while juggling applications, senior year & the pandemic, I managed to see all the videos from an Internal Medicine Board review and took an online-board review course.
Yet my performance in the question bank was dire.
I was disappointed but confident in my ability to overcome things.
If you've read my previous posts, you'll be familiar with all the stumbles and struggles that have gotten me here.
I moved to NYC that same summer to continue my medical training in Point-of-Care Ultrasound. My test was scheduled in NYC.
While my move was smooth, I had left my daughter and partner behind while I was arranging everything in the city. This was very stressful to say the least.
My plan was to move my Mother & daughter in with me before the school year began, while my partner stayed back in PR to care for our home and keep his job.
Those first months hit hard.
Being alone, in an empty apartment with scarce furniture and not so many friendly faces was tough. I was experiencing night sweats and tingling in my left arm.
I had been feeling the pressure of the exam, feeling fatigued, sore & tired.
While in bed I felt a very hard lump in between my neck and my clavicle.
The first thing that went through my head was a Lymphoma.
I stayed quiet, spoke to my PD and seeked medical attention.
As expected, this took my full attention and focus from the exam.
Later I found out the testing center capacity had been reduced in order to maintain COVID19 regulations. My scheduled appointment was cancelled.
I had to reschedule my exam. TWICE.
I continued my Fellowship, trying to excel in this new position.
Being in an IV League Medical School knowing all the struggles and set backs endured I felt like an impostor. I had never lived in the US before. The acronyms. The EMR. The Program Faculty was AMAZING and very welcoming, on the inside I felt very out of place.
Add to this the stress of a possible cancer diagnosis.
My mom & daughter arrived in the city. I was so glad they had come, but I was also terrified to share the news of a possible malignancy. While continuing to get worked-up, I tried to find some normalcy in the chaos. Studying since 5am, getting my daughter ready for school and leaving for my Fellowship. Getting back to the apt to have a light dinner, and returning to study until midnight.
When the time came for the exam I panicked.
I went into the testing center and came out empty.
I had no recollection of anything that had happened.
My work-up returned negative. I was healthy.
It was not long until I received my exam results.
I HAD FAILED.
I was DEVASTATED.
The feelings that came afterwards were overwhelming.
I felt like a wave had hit me and I did not know how to reach the surface.
The inadequacy, the self-doubt, the embarrassment, the failure. All that came with that result really shook me to my core. I no longer thought that I was a good physician. I was second guessing all my medical decisions. Things that took me little time to complete were taking very long.
I could no longer trust myself in anything.
You see, I had depended on myself for as long as I can remember.
I had never failed at anything. I had setbacks that were out of my control.
I always knew I could count on myself to show up and pull through.
I had failed myself and everyone that had a lending hand in my medical journey.
How was it possible for me to fail at something I had dedicated my entire life for the past 3 years?
Medicine was all I ever wanted.
Internal Medicine is all I did.
I had so many plans...
Working at a teaching Institution.
Returning home and bringing POCUS to my Program and other IM Residencies on the Island. Doing Locums or Telemedicine to have more family time.
I took the hit.
Experienced a devastating family loss that threw me into a clinical depression.
Times were very dark.
I pulled through with some help from a Psychologist, but I was a long way from gaining all I had lost.
Worked on myself confidence.
Finished my Fellowship & got my National Certification in POCUS.
Booked my Board exam.
During the last few months prior to my exam I was pregnant, AGAIN.
I was very happy with my baby, I was super stressed because I needed to take my test and knew it was going to be harder to study.
I studied hard.
Moved back to PR.
Started a job as a Hospitalist and took the ABIM for a second time.
2 months later results were back.
I HAD FAILED. AGAIN.
How was this even possible?
I did everything by the book.
Took the time off, studied hard.
Did 2 different question banks.
And still managed to fail.
Miserable doesn't even begin to compare.
The self-doubt returned.
This time harder.
I felt like a HUGE FAILURE.
I was really angry and upset at myself.
I needed to do something different.
My boss reached out, she wanted to check-in to see how was I feeling.
I think this was the first time someone had acknowledged my feelings.
Sharing her story with me made me feel seen, and less alone.
As everyone advanced, I felt left behind.
A non-certified Attending. Ugh.
How would my residents or students even see me?
What would they think of me?
I took time off from studying and focused on healing and forgiving myself.
How could I trust myself in succeeding when I had failed?
I looked into other possibilities that could have affected my performance.
These included my sleep disturbance; which I was reluctant to accept and receive treatment for. My emotional & physical health had to become a priority. I had 2 months to give birth and a LOT to work on.
I gave birth on November 14th to a beautiful baby boy.
Took maternity leave and focused on my baby & family's wellbeing.
Once I returned to work I began my board studying again.
This time with a different mentality.
It was arranged at work to take time off for studying.
My boss supported me in every step. This was so helpful.
I arranged child-care and was more focused on my weaknesses.
I traveled for an in-person review board.
Started medication for my sleeping disorder.
And felt physically and mentally different.
The time came for my exam.
The night before I reviewed many topics with one of my friends.
We were both about to take our exam the next day.
We spoke about my experience and what to expect.
The day came and I took my test.
I was in a different place.
My exam results were in the same day I was scheduled to return to work.
I had no idea.
While sitting at the gas station while on a call.
I received a text message from my boss congratulating me on by ABIM Certification.
I HAD PASSED.
I could not believe it.
I HAD FINALLY PASSED.
While I cried and screamed in joy.
Feelings of relief, excitement, gratitude, happiness.
Suddenly, disbelief. I had not received the results myself.
How could she know before me?
She called and texted a screen shot of my name and certification status.
It was true! I still couldn't believe it.
In the last months prior to the exam, and after
I had become a different physician.
My grueling journey to becoming certified shook me to the core.
It was a path of relearning and self-discovery.
Mostly learning how to trust myself again and gaining back my medical confidence.
Accepting my flaws and working on every aspect I could improve.
The most challenging part was being consistent.
It's easy to find distractions, make up excuses about not finding time.
It's easy to spend time on non-essential things and blame others factors for our failure.
It was very hard to look inside and accept I had failed. Harder to accept that it was my responsibility. I was not choosing scenarios that helped me succeed.
Looking back I can know identify the things that I could have done different.
But part of the learning journey is having experienced difficulties, in order to excel and overcome them. To me, this was much more than an exam. It was a life lesson of perseverance, endurance and not giving up.
I hope that by sharing my story others will know that failure doesn't define you, it molds you. Failure was necessary for me to rise above and thrive. If at some point you're struggling to succeed, know that you have what it takes to make it happen. You need to reach in deep.
