The Impostor

I just got my internal medicine evaluation. It's times like these that I feel like I've pulled the wool over everyone's eyes. My preceptor gave me "exceeds expectations" in almost all categories. I know that at more than one point I knew some thing she didn't know, but I really think that was just luck since I've been to so many conferences recently.

Preceptors always say "it may be just because of your background but...." it's their way of turning my older than average status into a positive. This one however was more specific - my experience and that I'm accustomed to working at all. I apparently have a strong work ethic.

When my patients tell me that they think I'm a great doctor, I assume it's just because they like my smile (or, like my little woman from Honduras, because they like my eyes). It's hard to believe that my patients know enough about the intricacies of what is going on behind the scenes to make these statements. That is so incredibly pompous of me to not think that my patients are able to make these assessments.

It's difficult for me to take compliments but maybe it's just as well because I always feel so stupid that I need to study constantly.


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Wanna Wanna Sweetie!!

I'm back to classes now in preparation for taking the MCCQE. There is an enormous amount of information we should have ready to complete the exam successfully. It's a bit terrifying to read through some of the objectives that I should have at my fingertips.

The fact that I've made it so close to the end of my medical school degree and feel this unprepared for the exam is unsettling. This is when the imposter portion of my brain kicks in and tries to keep me from focusing. One of the problems with reviewing for this exam is that you have many many options. There are books, including the Toronto Notes and the "purple book". There is a large number of US books too - USMLE Step 2 - and flash cards. I have so many books that can be useful already on my shelves too. Our class has also arranged review classes two nights a week. We have a large number of old exams that I can review.

There's a character that Terry Pratchett wrote, a little boy Wentworth who loves candies. He cries and cries for sweets during the books. Tiffany Aching is his older sister and she describes an episode at Wentworth's birthday where he is surrounded by sweets. He is so overwhelmed with the options that he is unable to begin to eat any of them. Wentworth sits, surrounded by the cakes and candies crying "wanna wanna sweeeetteeee". His mother is only able to squelch the crying by putting a bucket on his head and taking away all but 3 of the options. With the reduced number of options Wentworth is able to happily nibble away.

I need someone to put a bucket on my head.

Or even better, take away my study options.

Waffles; they're not just for breakfast anymore!

I keep waffling back and forth between feeling as though I am going to be the best doctor ever and expecting the big Gong Show cane t.m. to pull me off the stage. My class nominated me for an award. I'm in awe - partly because I'm pretty sure other people deserve it more, partly because I didn't think anyone noticed that I was there. There's a dollar amount attached to the award, so it would be fantastic if I actually win the thing.

I've decided that observerships are the best thing a med student can possibly do. I arranged to shadow a rheumatologist this week for an afternoon in her Osteoarthritis clinic. Her nurse was confused about my qualifications (thought I was a resident i.e. already an MD) and started barking orders at me about what I was to be doing all day. Given that I've covered OA in school already and feel comfortable taking patient histories from all the clinical methods training I've had (6 weeks) I was OK with it. When the doc showed up, she knew I was still in first year and didn't give me anything I couldn't handle. I was essentially catching patients' files up since their last visit by getting their histories (solo), interpreting x rays and learning a heck of a lot. Don't worry, the patients all knew that I'm just a student.

I left the OA clinic feeling like I could be a doctor right then and there!

Then I started studying again.

How is it possible that I can be so far behind when I work so much? I think I set my expectations for studying way too high. Re-writing every single lecture is too far. Ignoring weeks of material because I had the prof isn't far enough. Where is the balance they talked about in our first week?

Something I haven't mentioned yet is what I have going on in the background. I find it to be a struggle to keep up with what is going on in my home life and my school life. My partner has bipolar disorder. It's type II which means it's a mild version of the disorder, but that's not reassuring when I never know what to expect when I come home. I don't have the support here that I wish I did. It's not something that I advertise either, I don't want people to know what I'm dealing with. I'm not sure why I think it matters - probably just that I'm not ready to expose my weaknesses until I really get to know my classmates. He's on meds which is fantastic and tries really hard to be stable for me. No extra pressure at all. But if I can get through med school while dealing with his insanity (literally) I deserve then M.D. I'm given.

I guess I'll just keep trudging through until the cane pulls me off the stage.

I'd go to church but I don't like the wine

I keep waiting for someone in a white coat waving a cane to come running into the classroom, pointing at me and yelling that I'm not supposed to be there. So far this hasn't happened. It's only been 5 weeks though, there's plenty of time for that.

Before coming to school I was incredibly torn about what I was going to do for orientation week. Here I am, significantly older than my classmates, not able to hold my liquour (as a lovely going away party proved) but still wanting to make connections with my classmates. These are the people I'll be working beside, not only for the next few years but as my colleagues for the rest of my life. I want to make a good impression. I want to be someone that people will study with. But mostly, I want to be liked. Whoever said that med school is just high school, take two, wasn't exaggerating. The class is quite clearly divided, not just physically into front vs. back, left vs. right but also the partiers, the jocks, the book smart, the religious and me. I don't fit into any of the groups but seem to have been adopted by the religious.

It's weird. It's not that I don't like like religion. Many of the best religions serve wine at service which I can't help but endorse. It's just that it's not me. It's not just Christians in this group, there are Muslims as well. What will they all do to me when they realise I don't go to church? Will they wave a cane and kick me out as well? What will happen when even the religious nerds don't want me?

Due to logistical issues (I was commuting from another city) I didn't hit the major parties in O-week, especially toga. This meant that I missed out on a huge opportunity to meet a large portion of the class. I wanted them to get to know me before making judgements about me based on my age and my non-athletic nature. They will know soon enough that I've only got an average intelligence, that I'm not very quick on my feet and speaking of feet, mine spend most of their time in my mouth. I wanted them to get to know the fun me first.

As long as I can keep my mouth shut for the next few weeks, there's always Hallowe'en.

And so it begins...

I've had these nibbly little thoughts lately, ones that are desperately trying to get my attention and that I am desperately trying to ignore. I've been accepted into med school, I'll be starting this fall, but am I doing the right thing? Should I be taking the acceptance into a masters program instead? At least that would pay me to learn.

But most importantly, don't these people know that I'm just faking it? That I don't know if I can be a doctor? That I am an imposter? What if I'm found out? What if someone asks me an incredibly difficult anatomy question on the first day? What if no one likes me?

Chatting with some friends in similar, yet clearly different boats, I realise that I'm not the only imposter. There's a bunch of us hoping to fake it 'til we make it.

http://en.wikipedia.org/wiki/Impostor_Syndrome