As I sit in a dear friend’s apartment in New York, basking in the nothingness of vacation, I realize that the time left in the intern year of my Internal Medicine training can no longer be measured in months. It has been quite the year and I am part trepid, part excited to transition into a senior role in the next academic year.
This is not the first of such transitions for me, and neither was Match Day 2018 my first dance with the NRMP. I first moved to the United States in 2016 to begin an Anatomic Pathology/Clinical Pathology (AP/CP) residency. I remember putting all I owned into two travel bags – more like haphazardly stuffing the bags – and getting on the long-haul flight to Chicago, to begin the next phase of my seemingly never-ending medical training. I was excited and grateful to be part of the next group of exchange visitor physicians.
The arduous winding journey for international medical graduates seeking to continue medical education in the United States is one only for the brave at heart. From the grueling USMLE exams to the apprehension of Visa interviews at the US embassies, with a melange of sweetness whenever that FedEx envelope arrives with your ECFMG certification, culminating on Match Day where you finally get to know if you have been accepted into a program— is a summary of years of hard work, dedication and huge financial commitment. For those who make the mistake of thinking the process of getting in is the hardest, they soon learn that staying in is probably harder, confronted with an entirely new system of medical practice, far away from loved ones and the comfort of a familiar environment. What has kept many international graduates going is finding your purpose, understanding why you put in so much of your life to get to this point.
Have you ever done something for the first time and had great anxiety about doing it? If your answer is yes, we are in the same boat.
When I started my residency training as a first-year psychiatry resident, I had many fears and worries. Imagine a doctor who has to work in another country, use English as her second language, and see patients in a diverse population. I had fear that my patients wouldn’t be able to understand my accent; fear of judgment from my colleagues; and fear of making mistakes. The working environment in the United States is far different from Thailand. I used to write paper chart back in my country, but now I have to type everything to the Electronic Medical Record (EMR). In Thailand we have Universal Health Care Coverage, unlike the healthcare system in the United States, where everyone has insurance.
In 2002, the Mountain Goats, an American folk band led by John Darnielle, released an album titled All Hail West Texas. The first thing that struck me about the early years of the Mountain Goat’s records were how sparse they were, if this was stylistic choice or a means to an end, I do not know. It is well known that those early records produced by John Darnielle were recorded on a Panasonic RX-FT500 cassette tape recorder. The very last album he recorded in this way was about my current home, West Texas. In a lot of ways, the album resembles its namesake with its subdued melodies juxtaposed in a very plain, drawn out canvas the same way the West Texas sky colors, with its unique reddish hue and dispersed cotton candy clouds, the endless roads seasoned with scattered oil pumps throughout. This place is not for everyone, the same way the record is not. But when you see the beauty of infinity with an unraveling clear starlit sky and a sprawling desert that suddenly turns into mountains, it’s easy to understand why Darnielle sang about wanting these highways to be a Mobius strip that he could ride forever.
A beautiful Floridian morning is peeping through my window, when sunlight seems to be at her cheerful best, before it resigns to the daily routine. It makes a glittering appearance every day, warming up the beaches and boats, for the rain and the famous Orlando lightning would be due by noon. The shades of weather shall favor me today, as I reflect on a delightful journey, celebrating a lovely concoction of flavors.
It is interesting how we change shoe sizes. The leap into a second year resident’s shoes has been remarkable. As a PGY-2 in internal medicine at Florida hospital Orlando, I must admit that the second year of residency has been the best of both worlds so far. The worlds I refer to are two amazing phases of learning medicine. The first part is the relentless responsibility to learn at every step, and the second is sharing the knowledge and learning through supervision. It is challenging, yet very enjoyable, to extend my abilities and further the skills learned in the first year, to apply and practice medicine with a new sense of maturity. Expectations are higher, and it is the time for me to be prepared for added responsibility. It is time to make decisions for the team, be the second in command after the attending physician, and guide, supervise and organize with the interns.