“This cannot happen… I just started my career. Open your eyes. Move your fingers. Wiggle your toes. Do anything you can to let them know you’re ok!” These are the things I said to myself as I heard the commotion around me. As I felt the excruciating pain of the freshly inserted chest tube between my ribs, I heard someone say, “She might need to go on ECMO, let’s call the team.”
Unlike many of my colleagues in the medical field, I took a very unconventional path through my postgraduate training. Throughout medical school, I was convinced I was destined to be a surgeon. I loved anatomy, loved my surgical rotations, and thought that this was my destiny. Then on my first day as a house officer in general surgery, I stood for 9 hours in a laparoscopic hemicolectomy, without any breaks for eating or going to the bathroom, and suddenly my life choices became much less clear. I struggled a while longer, but eventually I put away my scalpel, took up my neglected stethoscope once again, and I took up a formal internal medicine training post in New Zealand, starting on another journey. Everything started to make sense for a change. The flow of hospital medicine, the critical thinking, the lack of having to stand in an OR for several hours with a full bladder and an empty stomach, it all finally came together. As it turned out, one shake-up was not enough, and as I rotated through stroke and neurology, I found a hidden interest that I wished to take further. Being inspired by some American mentors, I decided to apply for training in the USA, and began residency at the University of Texas (UT) Health Science Center, San Antonio Texas in June 2018. After all my continent hopping and specialty changes, at last I seemed to be on the right track.
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.
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.
I took a few minutes from my dayshift and ran into the nearest computer station. I calculated the time difference between the Eastern Time of the United States and Beirut for the tenth time. As I opened my email I had to make sure I was not misreading the words, “Congratulations, you have matched!” it said. Between the sigh of relief and the energetic mix of emotions, I could sense the smell of formaldehyde from the anatomy lab again and I could remember the late night study sessions, and it felt strangely more familiar than ever. Three months later, my paperwork and medical license have all been approved and it was time to say goodbye to the sunny days of Beirut and to welcome new beginnings in the windy city of Chicago.
Chicago offered nothing to dislike about it. The warmth of a very culturally diverse program and the amazing city scenes helped to ease the homesickness and the challenges of my internship year. The residency years in Chicago also witnessed me fulfilling my lifetime career goal to become a hematology and oncology physician, so before I could get used to the cold winters it was time for me to embark on another move to Houston for my fellowship.