I cried in the middle of a class. Again. That’s happened more than I would’ve expected in my life. This time, it was a Friday morning, before a really important exam.
In medical school, we have these yearly exams to make sure that we kind of know what we’re doing when it comes to patient care. They’re called the OSCEs, pronounced Oss Skeez, (Objective Structured Clinical Examination). We go from room to room with “standardized patients” (actors) who pretend they have some disease and we have to diagnose them by asking the important doctorly questions or performing the right physical exams or we have to deliver a difficult diagnosis, depending on which room we’re in. This happens while 1 or 2 real doctors stare at us with judging eyes and clipboards where they make notes of all the things we messed up and all the reasons why we shouldn’t graduate and don’t deserve to be doctors.
It’s terrifying and really really important. I’m in my last year of school and this exam represents the last significant hurdle I have to clear before I graduate. If I get past this one, all I have to do to graduate is not fail any of my classes or clinic rotations and that’s pretty easy, all things considered.
In the weeks leading up to my OSCE, my schedule was relentless. I was growing more nervous by the day and I had no time to deal with it. I sincerely convinced myself that I wasn’t smart enough to pass the exam, that I’m not worthy of graduating or becoming a doctor. It was a hard week. I became unbelievably fragile. Every small mistake I made was irrefutable proof of my inadequacy. I was so hard on myself.
The exam itself really is stressful but I think I was more caught up by the fact that I’ve been doing this for so long and I’m finally at the point where I can actually succeed. Becoming a doctor is no longer this theoretical thing that might happen down the road if I keep on plugging away. It’s suddenly coming down to a few tangible loose ends – then it’s over and I’ll have done it.
But of course, I don’t feel worthy. I’m not ready. I don’t know enough. I make too many mistakes. I have no idea what I’m doing. They can’t possibly let me be a doctor. I can’t graduate! As my Friday exam approached, I was extremely insecure and filled to the brim with self-doubt.
The night before my exam, I had a first-year student with me for my evening clinic shift. She followed me around and observed my patient interactions. After a patient visit, she told me how great it was to see the way I took the patient history and how impressed she was by the way I guided the discussion so I could obtain all of the pertinent information and come up with a reasonable diagnosis and treatment plan. She thought my physical exam skills were smooth and efficient. She said she learned a lot from observing me.
I quietly thanked her and told her I enjoyed working with her. I was struck by a memory of the first time I observed an upperclassman, the same way she had just observed me. I was just as impressed by the student I watched. But now I was that upperclassman and I immediately started having a really intense identity crisis. I felt confused. I didn’t know who I’d become. I didn’t know what I was.
As I was riding my bike home I had a definitive, defiant thought; No. She’s wrong. She was only impressed because she’d never been in the clinic before. She shouldn’t be impressed. My physical exam skills are not smooth or efficient. She just doesn’t know any better. I convinced myself that I’m a fraud and I was about to be exposed during my OSCE. That thought stung. It hurt. I started crying.
Somehow I made it home alive and fell asleep. (Don’t cry and bike, please. Very dangerous). When I woke up, I didn’t feel any better. I went to my morning oncology class even though I knew I wouldn’t be able to pay any attention.
Class started and the professor asked everyone to stand up. I stood.
He said, “Ok, now please sit down if you don’t exercise at least 5 days a week for more than 20 minutes a day.” I remained standing. I’m an athlete and I mostly train for hours a day. Even on my rest days, I run or ride my bike more than 20 minutes.
Then he said, “Ok, now please sit down if you have more than 3 alcoholic drinks a week.” I remained standing. Beer makes me feel like garbage and I rarely have more than 1 drink a week.
Then he said, “Ok, please sit if you eat less than 5-9 servings of fruits and vegetables a day.” I remained standing. Well, that’s pretty much all I eat and it takes more than 9 servings to get me through the day.
I was in the front row and facing the professor so it wasn’t until this point that I realized almost all of my classmates were seated. It filled me with anxiety. Please, let me sit down on the next one.
Then he said, “Ok, please sit if you eat less than 38 grams of fiber per day.” I remained standing. A few years ago, I set a personal goal of eating 45 grams of fiber per day and I put a massive amount of effort into figuring out how to make that happen. It took time and practice but these days, on a rare low-fiber day, I’ll still eat 40 grams.
I quickly glanced behind me and didn’t see anyone standing. I think there may have been a few of us left but I didn’t look hard enough to notice. Something interesting happened to me right then. I felt like a fraud. Like I should be sitting. Like I don’t actually do all of these things. I assumed everyone was looking at me standing and seeing through my blatant lies.
Of course, this is ridiculous because not only do I consciously do all of these things, I’ve actually practiced and put effort into creating these habits. But I somehow still felt like an imposter.
The professor gave a few more scenarios, sit down if you smoke, if you have an above-optimal body mass index, etc, and I remained standing. By the time the exercise ended (which felt like 3 hours) and I sat down, I was closer than I’ve ever been to having a panic attack. My heart was pounding. I was sweating. I was embarrassed. I was ashamed. But it didn’t make any sense.
The professor began lecturing on cancer risk factors and genetic predisposition and I didn’t pay any attention whatsoever. I was busy trying to understand what was happening to me. He turned the lights down and put on a TedTalk by some incredible doctor doing incredible things (I assume. I don’t actually know, I wasn’t listening).
I was trying to reasonably comprehend why I was feeling like a fraud when I got violently slapped by the answer. I felt like a fraud because I have some unrelated and unfounded insecurities. I was wrong to feel like a fraud. I exercise and eat vegetables and count my fiber intake. This is all completely true. I’m totally not a fraud.
It took another minute before I was struck by the implication of my realization; Maybe I’m also wrong about my skills as an aspiring doctor. Maybe I am worthy. Maybe I can graduate. Maybe all of the things I’ve dedicated my life to are actually coming to fruition. Maybe I am actually something special.
I started crying. Again. But this one was different. These tears came from a feeling I didn’t know how to process. An overwhelming emotion I absolutely was not ready for. Pride.
Luckily, the TedTalk wasn’t a short one. I mostly pulled it together by the time the lights came back on. The class eventually ended. I learned nothing about oncology that day.
Before I left to go to my exam, a classmate asked if I felt ready for it. I said, “No, I’m terrified.” She looked surprised, “Really?” She smiled. “I would totally vote you least likely to fail.” I laughed and thanked her.
I took my OSCE later that day. I really don’t know if I did well enough to pass. We’ll get our results in a week or so but I’m not very concerned with that. I gave it everything I had. I tried as hard as I could. If I fail, it doesn’t mean that I’m a fraud or an imposter or that I don’t deserve to graduate. It just means I have to try again. And while I still have my doubts, at least I know I’m really good at trying.