The Bigger Picture

By Dr. Becky Phillips

It can be difficult to explain to people outside the field of medicine just how important Match Day is to graduating medical students across the country. After months spent preparing for CaRMS, collecting letters of reference and attending interviews, the outcome of Match Day not only represents the hard work and preparation preceding it, but it also serves as the first day of “the rest of your life.” With your career finally determined, your formerly undifferentiated feet can begin confidently walking the path of your future.

Well, this is what they tell me anyway—I wouldn’t know. The day before Match Day, I died.

On March 2, 2020, my classmates and I were buzzing with excitement; match results were to finally arrive a mere 24 hours later. I had no reason to believe I wouldn’t be part of this momentous day, so I quietly buzzed along with everybody else, feeling the mounting energy swell inside me.

On March 2, 2020, just after 10 a.m., I missed a call while attending an orientation for my upcoming block. Plain as day, the caller’s information was displayed on my phone: University of Calgary.

With a sudden sense of dread, I stood up and walked to the bathroom, my mind seized by a kind of low-simmering panic I’d never known. Hands shaking, I leaned against a sink and hit ‘play’ on the voicemail. I heard a woman’s voice, gently explaining that she was from the Wellness Office—and I knew.

I hung up, my mind blank. I remember moving—floating, almost, like my legs knew to take over—straight to the Wellness Office. I was received with open arms and spent the next few hours shaking in the corner of the quiet room, curled into a ball and rocking myself. My parents, three hours away in Edmonton and my friends, stationed at various hospitals across the city, arrived as soon as they could. We all cried together.

Confusingly, I felt both a sense of empty numbness and of overwhelming emotion. I had watched my future collapse right in front of my eyes, just like that. The journey I’d made towards becoming a doctor had consumed my life for the better part of a decade. Often, I was so exhausted that the thought of my hard-won future career was the only thing that kept me going. I had never considered that I might not receive a residency position. The possibility never even entered my mind. So when I say, “I died,” I’m talking about the version of myself that existed until the phone call I received on March 2.

I hesitated before agreeing to the opportunity to write this blog. I struggled with the idea of sharing an experience as deeply personal and unique as the loss of my intended future. But I soon realized my experience was not unique. Others had walked this path before me; they had died, too. I thought to myself that after months of grief and introspection, I needed to take this chance to do justice to all of you, past, present and future, who join me as passengers on this roller coaster ride. I worried that I wouldn’t be able to say the right thing—or worse, that I would colour the experience in a way that disagrees with you and your reality. In the end, I decided to do this because—although your journey going unmatched is as important as mine—we are all entitled to sharing our stories.

I have chosen to stylize this blog as a “practical survival tips guide” to going unmatched and I sincerely hope it is helpful to you during this painful time in your life and career.

On dying and the grieving process 

  • I keep mentioning death because, in many ways during the first couple weeks, I felt like the old hopeful me had died. What followed felt similar to grieving, and for me, it was painful and lonely. Denial, anger, bargaining, depression, gradual acceptance—it was all there. For you, it might happen in a random order and may repeat itself. This is all normal. Understand that the confusion and mess of the early days will clear and eventually you will move from flat on your back, to sitting, to standing up, to walking.
  • Guess what? Only you get to decide how to mourn the death of your old life. Scream and cry? Yes. Leave the city immediately? Do it. Ignore your friends and family? Sure— they’ll understand. Deny reality and carry on like nothing happened? Okay, as long as it helps you. Do not let anybody tell you how you’re supposed to process this news. Your emotions are important and must not be avoided, quieted or ignored. Mourn in the way your mind and body decide to and do this for as long as you need. You’ll know when it’s been enough.

The Wellness Office 

  • Unless you did not give permission to release your results to your school, the Wellness Office will know of your match status before you do. I highly recommend giving this consent. Let your school show you how they plan to support you—that’s what they’re there for. The unfortunate truth is they deal with this every year, and your pain is not new to them. This means that they are well-equipped to help you through this. During match week, they exist to support and guide you through a process foreign to you but routine to them. You don’t have to accept or believe anything they say, but please at least consider this very important resource. Your life has been interrupted. This is a time for partial suspension of your self-control and acceptance of new strategies.

On reaching out for feedback—and closure

  • As my school did, your school may suggest that you reach out to Program Directors for feedback regarding your application and interview performance. This is optional, but when it was proposed to me, the word “closure” was used a number of times and I was gently encouraged to pursue this route. I will say this: I don’t think anything could ever provide full closure when I ponder going unmatched, but I did have a great experience speaking with the directors. Approximately half responded with similar feedback, and each had their own words of wisdom and encouragement. One even shared with me his long-ago experience not matching. Hearing from these physicians steadied my rocking boat and helped me take on the waves; it was relieving to know there wasn’t something grossly “wrong” with who I was. In a way, this represented the beginning of externalizing some of the factors that lead to my match status, rather than the constant self-blame I’d been living with prior to it.

Mental health 

  • I hardly need to explain the ways in which going unmatched will impact your well-being. I urge you to accept your school’s offer to connect you with mental health support. You may only need to meet with them once, but the opportunity to speak with a supportive neutral party about your feelings—even if you’ve never done it before—can be an important source of assistance.
    Having an objective ear to listen, someone who has no personal stake in your placement, is incredibly beneficial. In my case I was connected to a psychiatrist, who I still see, and who I’d never have met otherwise; she has had a significant positive impact on my mental health, both generally and with regards to the match. I would strongly encourage you to give it a shot.

Brotherhood 

  1. If you do nothing else, DO THIS! Please, please, please meet with your fellow classmates who have also gone unmatched. Your school may organize a formal gathering and will invite you to attend; this may be your first opportunity to see that there are others living the same hell that you are. Trust me, nobody knows your pain like someone else going through it too. You can compare field notes as you navigate life after match day. You can rant and vent and cry together. Before I knew of the others, the loneliness of going unmatched was paralyzing. I’ve never felt so singularly alone—it was like my class had run off to the races, and I’d been clotheslined at the starting point all by myself. Loneliness is one less thing to juggle if you are willing to connect with your peers. Be an ear to them. I found focusing my energies on supporting others helped me to process my own sadness. I’m not a particularly social person, and I wasn’t close friends with any of these peers beforehand. You may be the same. But, face it: you’re now bonded in a unique and terrible way. Take this opportunity to share your grief together.

On stigma, owning your truth, and telling others 

  • I was told it’s up to me whether and how to tell others of my status. Sage advice, but poor applicability in the real world. When you return to clerkship post-match, the question on everybody’s mind is where you’re off to. Please know this is a well-intentioned question and the person asking is simply making conversation; they are excited for you. After all, matching is far more common than not matching. I cried the first time a resident asked me this question despite my fierce preparation and rehearsal of what I’d say. So… I don’t have the perfect answer for how to handle these scenarios, because there is no perfect answer. In the early days, it’s going to be hard to constantly utter the words over and over again, but it will get easier. Be prepared for the overly sympathetic and guilty response and try not to roll your eyes. Grit and bare.

 

  • Now that I’m months out from the match, I’m happy to tell others about my status because I’ve decided if I don’t own my truth, no one else will. I’m proud of the person I’ve become due to this experience, and I’m happy to represent and humanize the unmatched. After all, I worked very hard in school; I realized that I have nothing to be ashamed of. I believe the more we talk about the possibility of going unmatched, the less stigmatized and shameful it becomes. Of course, your mileage may vary. It is entirely up to you whether you want to reveal your vulnerabilities, and if not, it’s easier to blunt the truth once you’re a clerk again or a new R1; unless someone specifically asks you about your match experience, which is very uncommon, everyone assumes you’re just like everybody else. Take no shame in keeping your journey to yourself if this is what feels right.

On coping with the next steps 

  • That came quickly, didn’t it? You’ve just been dealt this awful news and within days you’re thrown headfirst into second iteration. I found it immensely frustrating, difficult, and demeaning to shuffle through the available specialities and hurry to book shadowing time all while still reeling from the abrupt end of my original plan. Suddenly the decision you spent months deciding on has been distilled to a few rapid-fire days. Common advice is to shadow specialties ad lib, but I’m not sure how helpful a single day with a single preceptor can be during a time like this. Now is the time to swallow the knot in your throat and focus: how are you going to move forward?

 

  • You are going to feel like you’re in a pressure cooker. Sometimes there are specialities available that you already like and can see yourself doing, and other times there’s nothing. You will likely be required to apply to something in second iteration, but this doesn’t mean you need to rank. Try to briefly clear the fog in your head and think seriously about what you can reasonably see yourself practicing in twenty years. If you genuinely aren’t happy with the options in second round, then your school will guide you through an extended clerkship. Don’t forget: your school is still there for you every step of the way. You do have options, even if it can feel like you don’t. You will be encouraged and perhaps required to explore a diverse number of specialties, but it is also your prerogative to re-apply to your original desired field. In this case, try to clarify how you can improve your application via feedback from Program Directors. Do more electives in cities you hadn’t originally considered— you might find a place or position you fall in love with. Most importantly, keep an open mind. Explore areas and locations you may have glossed over and decide if these new options could serve you well in your future.

The bigger picture 

  • Going unmatched will force you to step back and reconsider what it is that you want with your life. You will ask yourself why you chose medicine and if it’s really what you want to spend each day doing. For me, not matching was a reminder that there is life outside medicine and this life is critical to my happiness. I’ve made choices that allow me to indulge the many parts of myself that have nothing to do with medicine and that bring me fulfillment and joy. I can’t lie—I still probably would have chosen to match had this scenario been presented to me again, but I cannot deny the strides I’ve made in personal resilience and tolerance building.

My story has a happy ending. I matched in second iteration in a program and city I’m very happy with. I have an excellent support network and satisfying hobbies. I’m five months past the day the old me, with all her boundless optimism, died. But here’s the thing, the silver lining it took me months to notice: each day, I grow a little more grateful for the experience. You might be wondering—grateful? I’ve realized that, if nothing else, I’ve come out the other end of this more patient and empathetic than ever before.  The qualities I’ve been forced to develop through this process have made me a better person and physician. I know I’m already better at articulating my feelings—and at helping others. Though I’m not ready to declare that going unmatched is a “good” thing, I do think that it might be one of the most important things that has ever happened to me.

I hope you find wellness and peace as you walk this road. I’m always available to anyone requiring support through the process, or for any questions. Please feel free to contact me any time; rphilli1@ualberta.ca.

 

Written by me on March 3rd, 2020:

Untitled

Here we are, to you I say,
Today’s a rather awful day.

Tomorrow also, and next week too;
Mourn the former, hopeful you.

I’ll save you some time, eye rolls and pain;
Here’s what the well-intentioned will say:

“It’ll all work out, it’s totally fine,
You’re still a great person, a brilliant mind.

Just a small bump in the road, you’ll look back with a smile,
So thankful to walk this resiliency mile.”

Okay, understood; that’s well and fine
Still today lay in history a terrible time.

And if anyone dare say, “it could be worse, hey”…
You have my permission to just walk away.

I know not your pain but I know mine,
If nothing else, treat yourself kind.

And know that when antiques are restored and repaired,
They’re worth far more than the unchallenged and bare.

 

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Dr. Becky Phillips is a general pathology resident physician at the University of Alberta.