Friday, February 9, 2018

Completion of Medical School, Match Day, Marriage, Medical Specialty, Life!!!

I'm reaching the age where it's not unthinkable to consider marriage, although i personally think I'd be getting WAY ahead of myself to proceed too far into planning it or even thinking about it when I have no likely candidate in mind. A little over a month ago, I at least had a candidate. I wasn't taking his candidacy too seriously, nor was he, apparently, since he broke it off by phone over Christmas vacation. (The two of us were not yet engaged to be married.) My brother continues to remind me that the guy was at least classy enough not to have ended the relationship via text. I would have preferred an in-person break-off, however inconvenient it might have been. However, as much as I hate this statement when anyone else says it, I shall use it myself this once: it is what it is. The guy broke it off by phone. He could have hired an airplane to fly past my ski resort when he knew I would be outside, with a banner trailing the plane, spelling out the words: "We're finished, Alexis. Get over it!" almost in the style someone (his ex Stephanie March insists she had nothing to do with it) repeatedly flew above Bobby Flay at the podium as he attempted to give his speech prior to his star on the Hollywood Walk of Fame being dedicated. The banner trailing the plane disturbing Bobby Flay's ceremony read simply, "Cheater!" Sometimes the laconic approach is best. I couldn't have expressed it better myself.

In any event, I checked out the statistics for medical school students and interns/residents. It seems that, even with statistics for marriage overall showing a decline for individuals in their twenties as opposed to in previous decades) nearly half of medical students at my stage of medical education have already tied the knot. That surprised me, but I found my roster of students in my own cohort and counted. Out of the one-hundred-three students remaining in our cohort (As late in the game as it is, our number may soon drop by one. It seems that one of our members has found herself in warm if not downright hot water. Regardless of any connection the situation may or may no have with me, I'm staying out of it on both sides. I won't plead for mercy on her behalf, nor will I offer any evidence against her unless I am compelled by my superiors to do so, and such seems highly unlikely at this point.) forty-nine of the one-hundred-three are presently married. Two are on their second marriages (Where in hell do these people find the time for this level of activity?) and five of the presently single cohort member have been divorced. As far as who is currently contemplating divorce or even has filed for such, I haven't the foggiest notion. i'm doing well to know who is even married. I wouldn't know who had been divorced were Celinda not sitting here with me and cluing me in as to the marital status of the respective members of our cohort.  She somehow has time to keep up with such minutiae.  Numerous members of the cohort (even Celinda doesn't know the exact number but she estimates it to between ten and twenty) plan to get hitched during the break between graduation and the start of internship/residency. Interestingly enough, none of our cohort members are married to one another, nor, as far as Celinda knows, are the scheduled upcoming nuptials between any of our cohort members. While I'm the last person who should be providing marital or premarital advice, it would seem to be a wise act for a variety of reasons not to marry a person in one's own graduating medical school class at the same school of medicine, at least while the two are both enrolled in medical school. There's plenty of time later to develop the relationship and to make it legal if doing so seems like a good idea later. 

I find it highly dubious that anyone still reading this actually gives a flying squirrel's rectum about the percentages regarding relationships, though I'll share the numbers anyway because I've always been a math geek. It rounds up very slightly to forty-eight of my cohort mates presently being married. Fifty-two per cent of my cohort mates have been married. Counting all marriages, divorces, and remarriages, fifty-six marriages have taken place among members of my cohort. If we allow the divorced members to skew the statistics -- and it is a clear skew of the statistics -- fifty-four per cent of the members of our cohort have been married. 

One statistic I found interesting though not terribly significant is that -- depending upon whose statistics one chooses to believe, students enrolled in programs leading to degrees in osteopathic medicine have a significantly higher chance of marrying before their final year of formal schooling has been competed. One source I checked had sixty-eight per cent of the  D.O. candidates married by their final semester (or penultimate quarter depending upon the system) while another listed their rate of marriage in the same time period at seventy per cent.

I won't use this time to go into the differences between traditional (sometimes referred to as "allopathic" medicine and osteopathic medicine). Historically, the two evolved from the study of extremely different  forms of medical treatment, with osteopathic medicine focusing heavily upon musculoskeletal adjustment of the body. While  osteopathic medical students continue to receive more treatment in the study of musculoskeletal adjustment than do traditional medical school students, osteopathic medical students now receive considerably more training in areas considered "traditional medicine."  I don't wish to burden anyone with my own prejudices concerning osteopathic medical training, nor do I wish to engage in arguments with anyone concerning the same. I will say (and some will disagree)  that students in osteopathic programs were frequently rejected from traditional medical schools, and I will also say that students enrolled in traditional medical school programs post an average MCAT (Medical Schools Admission Test)score of 31.4, as opposed to the mean score of those enrolled in schools of osteopathic medicine , which is 25.31. Some sources have suggested that acceptance rates as schools of osteopathic medicine are lower than at traditional medical schools. if such is indeed the case -- and I'm not 100% convinced it is -- it would be, in my estimation, in part because students apply to osteopathic medical programs who know they haven't a ghost of a chance at admission to traditional medical programs and that osteopathic medical programs also deal with applicants who have been rejected from traditional medical school programs.

Prospective doctors of osteopathy take different board exams (COMLEX) than do doctors of medicine (USMLE). There may be very legitimate reasons for the different exams. Were i the god of Medical Exams, and particularly if I were in charge of prospective osteopathic physicians and the exams they were given, I would insist upon doctors in both programs taking the same exams. Osteopathic physicians frequently face attitudes of superiority from doctors of traditional medicine. Were i an osteopathic physician, I would welcome the opportunity to demonstrate that my knowledge, at least as measured by  single test, was equal to or superior to a doctor of traditional or allopathic medicine.  Alleging that one's test is actually more difficult than the test taken by doctors of traditional medicine, even if it happened to be true, which I highly doubt, doesn't cut it as an explanation in the real world. It's similar to most of the private schools in my area (typically the Catholic Schools), which insist on giving the equivalent to Form B, or the test that is offered in the fall, instead of giving its students Form A, or the identical test public school students take in the spring each year.  Private school administrators give all sorts of bogus explanations, sometimes even going so far as to outrightly lie and to say that their students took in the fall the identical test that the public students will take in the spring. Such is blatantly untrue. The test the private school students typically take in the fall is a slightly modified version of one the public school students took the previous spring, usually amended to make it slightly easier because it is given so early in the school year that students haven't had adequate time to recover what they may have forgotten over the summer.  (I use Catholic schools as an example here because it would be an unfair comparison to pit preparatory schools with annual tuition of an absolute minimum of twenty-two thousand dollars against public schools. The two groups of student populations have nothing in common. With Catholic schools, while they have a slight socioeconomic edge over public when considering both mean and median income and the fact that Catholic schools can and do reject anyone they would prefer not to have among their student bodies, it's still close enough to be an almost level playing field. Catholic schools should relish the opportunity to kick the public schools' butts on standardized tests each year. Instead, they give different forms of the test, yet still try to boast of their superior performance despite it being an "apples to oranges" comparison.

I use the two rather unlikely comparisons because in both cases, in my opinion, one group is opting not to take an identical test as the other when it would be a perfect chance, if the claims made by the smaller group in each case have merit, to demonstrate superiority or at least equality. If the osteopathic programs consider that they must test, in addition to the standard medical curricula, the musculoskeletal content covered in their program, they could include an additional test covering those areas, and could require their candidates to pass both exams in order to be eligible to practice medicine. While I will likely work with many doctors of osteopathy during the course of my career, Ido not wish to carry a chip around on my shoulder in relation to the supposed superiority of my training as compared to theirs. On the other hand, if I am brought to an emergency room with severe cardiac symptoms, I desire to be treated by a physician who has passed the respective required versions of the USMLE as opposed to the COMLEX with its extra two-hundred questions about musculoskeletal manipulation. I'll now climb off my soap box and return to my discussion of marriage as it relates to medical school and the practice of medicine.

I wouldn't really consider medical school to be exactly a microcosm of society for various reasons. What I would consider it to be is a multicultural, multi-societal, multi-geographical, multi-communal mixing bowl. The percentages of the racial breakdown of our cohort and of the medical school as a whole almost certainly exist on someone's computer and in a file cabinet somewhere, and they're probably being used as I type to attempt to gain additional funding due to a higher-than-average percentage of females, Asians, Africans, members who identify as LGBTQ or whatever is the current acceptable term, individuals with physical disabilities, individuals from backgrounds that would qualifying them as being economically disadvantaged, and individuals who have suffered what someone reading through stacks of applications would consider to have been significant trauma at some point in their lives. 

We, with our widely varying backgrounds, were thrown together into a lecture hall or two or three, and, perhaps most significantly, a human cadaver lab. Before ever being granted access to any actual hospital corridors abutting rooms containing live patients, we bonded over difficult content, demanding professors, and the dissection of cadavers.  It's truly a bonding experience. In some cases it's more of an un-bonding experience. Just as you grow close to some over shared trials, you learn through adversity that there are other individuals in the company of whom you will never spend more than five seconds if you are not required to do so.  A great deal of dating happens between cohort mates, as your dating pool consists largely of those with whom you spend time. A considerable amount of sex also happens. Most of us are at an age at which our hormones are running amok. The sex that happened in closets on Grey's Anatomy wasn't entirely a case of Hollywood's attempt at making things more titillating for viewers. It happens, though usually at someone's apartment and not in a hospital supply closet.  Some positions are more comfortable than others, not all hospital supply closets have locking doors, and there's a reason God or at least someone invented beds.  

Dating practices notwithstanding, practicality ended up leading most of us in different directions when it came to more serious relationships. On Friday, March 16, most of us will learn where we will serve our residencies. Either we can opt out of the program after our initial year our internship, or the program itself can opt out and invite us to continue our training elsewhere. Regardless, we're contractually committed to any institution with which "the computer" (I'm sure there is more than one computer involved, but it's always referred to simply as "the computer") matches us. We dash all over the nation having interviews while also trying to get views of hospitals and communities. We then submit lists of our preferences of programs in order. The teaching programs at hospitals also rank us in order of preference. We're assured that the system is fair and that it does not place preference of the institutions' preferences above preferences of the students, and that a fair and equal balance exists. I'm convinced that we're not far from knowing exactly how it happens, and the disclosure of how it works will, within a very short number of years, force the system to be "fair and balanced" (another term I've grown to detest but will use it here anyway), but for now, we as students  have no choice but to take the computer's word for it and to take the match that we're given.

For most of us, Match Day is perhaps the most exciting yet simultaneously the most stressful day of each of our respective lives. While we can opt out 9or be kicked out) after a year, that's not what most of us anticipate. we assume that our match will be for the duration of our training. That if we aspire to be general surgeons, the next five years of our lives will be spent at that institution. For a few specialties, it's a three-year commitment, but for others it can be six years.
We're stressed about being accepted into a program of our choice. We're anxious about the location. Imagine adding to that the apprehension of where a spouse or prospective spouse might end up in relation to where one's own residency might be. I can't imagine it, which is a reason I've chosen not to become too closely attached to anyone who faces as little control as I do over my immediate future. 

Some of my peers have girlfriends and boyfriends within the cohort. They'll choose whether to break things off cleanly, try to make a long distance relationship work, or somewhere in between. In some cases they may even get lucky and end up at the same institution, or very near. They'll find that they have very little time off, and what time they do have off may not coincide with the time the other has off. Their relationship may soon be history. Or maybe it won't Some relationships succeed against seemingly insurmountable odds.

My brother is in a relationship. His sweetheart is a registered nurse who will soon complete her certification as a nurse practitioner.. If it's what they decide to do, she will be able to travel to wherever he goes. Registered nurses and nurse practitioners can work almost anywhere. My brother and the woman in his life face the same hurdles anyone faces who is either a physician in training or who marries or attempts to maintain a relationship with one. The odds are probably technically against the success of their relationship. Technical odds are beaten every day of the year, though. It's all up to them The world is their oyster, whatever that means.

As for me, as much as the recent breakup hurt, I'm very relieved to be entering this new phase of my life with virtually no encumbrances.  I have a better-than-average chance of ending up where I think I will be matched, and it is my first choice. My plan, assuming I end up where I think I will be, is to spend the full five years there and walk away with the multiple certifications I hope to earn. If the ulcerative colitis situation doesn't improve, which I don't believe will be the case: for once in my life I shall dispense with my usual pessimism and will think positively; while colitis may always be a part of my life to some degree, it will improve, and I will function as a normal person to the degree that the specialty in which I ultimately practice will be a matter of choice and not a matter of default due to health concerns. 

I don't need to place any sort of time limit on a relationship. As it is, I'm barely the age most people are when they begin medical school. and I will have finished up all of my coursework in ten weeks (four of which will be spent on vacation!!!!), and will be graduating in roughly four months. If somewhere in the next few years, I find a person I'd care to share my life with, it will be sublime. If not, I have an astonishing career to which to look forward, I'll earn enough money to travel to exotic locations, and I can date or not as I see fit. Three members of my cohort have made proposals of varying sorts, but all are along the lines of "If neither of us is in a relationship in X number of years, we should meet up and see whether it would work out between us." I haven't said yes or no  to any of them, but if the time is right, I'll explore the options.

There are people who are my age of twenty-three who are working at Burger King while they try to pay off student loans as they try to find some way to use their relatively useless degrees.  And those are the ones who are relatively fortunate. Others have changed their majors four times and haven't yet completed their bachelor's degrees. They, too, are among the lucky ones. Still others are divorced (or never married) with a child or two to support with or without financial help from the child's or children's father(s). (I've vowed to stop using the term "sperm donor" to refer to baby daddies. It's an insult to legitimate sperm donors, who perform a valuable service to society. Thanks, Knotty, for opening my eyes and changing my perspective on that.)

I will very soon have not only my M.D., but a bachelor of science degree in biochemistry that I earned four years ago, in addition to Bachelors of Fine Arts degrees in piano performance, violin performance, and musicology. I didn't originally have the musicology degree, but my music faculty adviser looked over my transcript and noticed that I was a mere two courses short in that degree. I completed the courses online just for the hell of it.  If I really don't like being a doctor, I can probably find something to do with my music degrees. It probably won't pay tremendously well, but there's always busking as a way of supplementing one's income.

Marriage is something that I hope is in the cards for me. I will be cautious. While I don't necessarily wish to be married to another doctor, neither do I wish to be tied to someone who loves my salary more than he loves me. That's not to say I wouldn't consider having a stay-at-home husband for a few years while children were very young if he happened to be really good at it.  However I view it, though, barring some unforeseen tragedy, the possibility of which is so remote that it's pointless to waste time worrying about it, I have lots of time before needing to decide much of anything of consequence, and I have the potential, even without relying on my medical degree,  to earn enough money to live as well as anyone reasonably needs to live. Gold toilets or other features of the Trump Tower or other equally opulent places aren't things I need or even want -- ever.  Marriage to the right person sounds like a wonderful prospect, and I hope it happens for me eventually, but if it doesn't. I'm prepared to create a happy life for myself.

i don't own this video. Thanks to the rightful owner for allowing me to borrow it.


  1. That was quite a post. I have been part of the lives of a handful of doctors, male and female, some friends and some lovers and am now watching them at an age they can retire should they want to. Only one married another doctor and I was during residency that they met. One old flame never did marry, but she is an awesome doctor and in a long term relationship last I heard. There are many possibilities. I would think a relationship with you would be challenging, but mostly just in keeping your interest. It will have to be someone quite special, but they are out there. I know this because I have met some of these people and they are fascinating. I will be curious to know where you end up so as long as you keep writing I will keep reading. Best of luck with your match.

  2. I've gone with the Canadian option first. If that works out, it will be my match. I've only listed three U.S. programs for if the Canadian thing doesn't work out. One of my professors thinks I am bat=shit crazy for giving myself so few options, but I don't want to be committed to a place I don't like. I can scramble for a position and find something if I don't get a match, and I have chosen to trust the Canadian program to do what they say they're going to do.