a young pakistani doctor blogs...
Friday, June 03, 2005
  More on an introduction II

My current gripe.
I have my final year exams starting in 83 days. That is not a lot of time, because the amount of material I have left to cover is immense. I started studying for the exam around March. It’s the 3rd of June now. Since then, I can fairly say I’ve studied some 6 weeks altogether. The rest of the time, I just got sick and tired of studying and just flat out stopped. That is not to say I enjoyed myself instead – on the contrary I just lay about somewhere feeling miserable and low for not studying. If I feel I’m failing in my objectives, the low self-esteem really kicks in and has me feeling just about as important as a sack of crap in the overall scheme of the universe. I lose confidence in myself, stay indoors, tend to avoid people, look for ways to escape myself and my circumstances, I overeat… the works.

But six weeks of studying overall is not bad going really. That’s probably more than what most of my class has clocked in. At least I like to think so! I have a good chance at coming somewhere in the top 10% of my class if I get my act together and start studying properly. That’s one of the reasons I’ve decided to start a blog.

For now, since the upcoming exam is the Most-Important-Thing-in-the-Universe-in-the-History-of-Mankind, this blog will be mostly dedicated to following my progress (or, God forbid, the lack of it!) in my preparation for it.

And of course, the ramblings that result when my mind wanders to issues I shouldn’t be thinking about when I’m “hard at work”. Ha ha.

I’ve had a bad five years in medical school. In the college (they don’t call it medical ‘school’ over here- and my institute of learning is a college, not a university) I go to, it lasts about 5 years, not four. We’re old, broken men and women by the time we are spit out of the tail-end of the system; as opposed to the bright-eyed, enthusiastic youngsters we were entering it.

In Pakistan, there is no concept of a pre-med undergraduate degree. You decide to become a doctor at the very tender age of 16 when you enter a pre-med high school course that lasts 2 years. So you end up entering medical school at the age of 18, and you’re spit out at the age of 24. I’m 25, a year older than most of my classmates because I lost a year down this long winding road. I’ll save the story of the lost year for another day.

As I was saying, I’ve had a bad 5 years here. I’ve always been, throughout my innocent youth, a top student. When I came to medical college, my faith in my academic abilities eroded very fast. It’s a process that continues to this day. Everyday I spend not studying (when I should be) is a blow to my self-confidence. And believe me, I’ve had many many blows struck against me. I’m bruised and battered on the inside. This blog is a way to get a grip on all that emotional gunk that has build up over the years and try to just deal with it! I have to get past myself if I’m to succeed. What is success? Here are my current goals:

I don’t have an exciting life. My mind is ravaged with thoughts of, and the tensions of studying. This has been going on for 5 years now. As for the current final year exam, I know it’s very tough to contain the entire course of final year medicine in your mind for a month-and-a-half-long exam. It takes its toll, and I know for a fact that I’m not the only one who finds it difficult.

But I’m different! I’m better than the rest who do find it difficult and who get panic attacks every now and then. Aren’t I??

No, I’m not. But I wish to be. I want to be strong, well-balanced, confident, and consistent in my efforts. I’ve failed in one subject or the other in the preceding 4 years. Each failure has been met with a colossal loss in my self-confidence and self-esteem. I wish to turn all that around in a grand sweep by passing my final year with great grades. I guess I’m putting a lot into my success in final year. A lot depends on it. My parents have watched me descend the academic ladder I was once at the top of with no small degree of foreboding. They’re worried about me and my ability to deliver. I want to relieve that disquiet, both in their minds and in mine.

I live in Pakistan. I am a Pakistani, although I was born and raised (i.e., till I was 17) in Saudi Arabia. Mine is a poor country, and being an “upper-class” here is the same as being low-middle class in the west. A middle-class in this country (and this group forms the majority of the population who are not officially poor) struggles to make ends meet, struggles to enjoy their lives. A middle class man in this country may very well not be able to take care of his family all the time. He may fail by being unable to pay for any medical expenses he or his family may incur, may fail when it comes time to put his kids in a good school, may fail by not being able to afford a car, may fail by being forced to live in a combined family with (God forbid!) his own parents until they die and he’s 42 and inherits part of a house he has to share with his 3-4 brothers.

I don’t want that for myself. My father was poor. He was born an orphan. His mother died soon after he was born. He struggled and struggled till he got a PhD and a good job in Saudi Arabia. I was born shortly afterwards in Saudi Arabia. Now I’m all grown up, and my father looks to me to be able to take the torch and carry it even further than he did.

I’m a final year medical student. The most important time in my life, the most critical time in my life is coming up. I need to get my shit together! I want to be in a position to take care of my parents when they get old(er). I don’t want them to die thinking I’ve failed them, or even worse, that they failed as parents.

Hey, why is final year so friggin important anyway? Chill out, why doncha!
Good question!

I’ve got three brothers. Let me talk about two of them. One is older. The other is younger. The younger is a friggin genius, and is doing very very well for himself. Pretty soon, he’ll have a great job (in the computer programming world) in the States. He went to America recently to do his masters in a very prestigious university. He’s my family’s success story. The older one, in stark contrast is a ‘failure’, as defined (fairly, I think) by my father. After ‘high-school’ in Saudi Arabia my father sent him to Europe to get a bachelors in engineering. To cut a long story short, he didn’t get the degree, and instead flushed some $ 60,000 of my father’s money down the toilet. He just stopped studying, wasted his time there and finally, after two years over the time it would have taken him to finish the degree, my heartbroken father brought him back.

Two stark extremes, wouldn’t you say? One is my father’s pride and joy. The other, a source of heartbreak. One moving on to great things at the tender age of 23, the other still living with his parents, barely making ends meet with a shitty job at the age of 35. And here I am right in the middle. Which way will I go? Which brother will I follow? My parents are concerned.

My marks (i.e. ‘grades’) in my first, second and third year of medical school were no good. My first year was absolutely horrendous. My second year better, and third year a little better still. However, in all 3 years, I flunked a subject and had to take it again - a source of great disappointment for my parents. Fourth year, I finally got through in the first time around, but then too only by the skin of my teeth.

Now here I am in final year. For those who haven’t read my previous posts, the stupid medical college I go to has an annual system (as opposed to a semester system). We have one giant exam on a certain subject lasting 3 hours which, when graded, will represent the entire years’ effort. Till that exam comes, there are no quizzes, no regular timed smaller-scaled exams, no assignments, nothing. The exam is not multiple choice either, but essay type. So people who can write really fast and really neatly always have an edge. So you come in on a fateful day, take the written exam and that’s it – your whole year summed up in a 3 hour orgy of writing. Its insane. There’s been talk of reforming the system, but I’m leaving the college soon so I don’t really care. The uncaring, uninterested, unmotivated teachers who failed us so miserably can take their talk of reform and their solemn self-righteous pleas for change and shove it up where the sun don’t shine. A plague upon their houses! [I do hate them so. They’ve betrayed the trust they’ve been given to educate.]

I’m sorry, I got carried away! So much that’s eating me up, frustrating me. These pressures! (God, I’m such a whiner!)

Anyways…back to the final year exam thingi. Its important because what I do in it will be sort of a metaphor for the new me. A good score will show that I’ve truly changed, that I’m truly taking command of my life and am back to my former glory days when I used to be at the top of my class all the time.

The thing is I’ve gotten engaged. I am now linked inexorably to a wonderful woman. Can I provide a good life for her? Can I live up to the promise of the capabilities that I know I have? Can I master my capriciousness and study when its time to study, no matter my mood? Can I get my shit together? I hope so. She’s trusted me a lot. Getting engaged in my society to a person of your choice before you’re financially independent is a tricky proposition. I’ve managed to do it, but only after promising everyone (i.e., my parents, her parents, and her) that the day when I stand (very firmly) on my own two feet will surely and truly come. If I can’t pass a friggin college exam after all this time, after all these promises, then can they trust me to take command of my life in the future? Can they look at me and treat me like a man, and not some repeatedly fumbling, incompetent, weak, undisciplined loser?

The final year exam is a real test. I made promises. I told people I’d deliver. I have to now. Back to the wall and all that, you know. It will determine how much they trust me to guide my own future in the coming year or two.

And what happens in the coming year or two then?
After I pass my final year exam with brilliant grades, I will proceed to study for my USMLE exams so I can work as a resident, and later as a fellow in the US for a number of years. The USMLE exams are very very tough if you need to score highly in them, and I, as a Paki doctor-to-be do need to score very highly in them. Unlike many doctors/medical students in the US, we paki doctors (actually, all foreign doctors seeking further training in the US) need high scores to get into respectable programs in the US. I’m talking about 90s high. I’m hoping for a 99 on at least one of them.

High scores equals to good chances of getting a residency in the US equals to financial independence equals to the final hurdle to self-sufficiency and ‘success’ as defined by my society, my family, and therefore the universe. It will also mean that my parents will finally be able to rest at ease in their old age, content in the knowledge that the torch will be carried on, and that all the hard work they put into raising me, all the sacrifices they made in giving me a good education, all that has paid off. I want both my parents to rest easy in the twilight of their lives. I want to be able to shield them for a change, to provide for them for a change, to tell them that they never have to worry about money again as long as I’m alive.

But if I don’t do well in final year, how can they believe such a day will ever come? How can I? They’ll worry incessantly about me until my feet land in America and I actually go to there to work – if that ever happens! They’ll keep treating me with no small degree of justified distrust, worried that this son of theirs may never make it all the way like they had once believed he could (and would).

How can I trust myself if I don’t deliver in final year? I know I have it in me. I have to clean up my act. No more whimsical, stupid escapist day-dreaming (I do a lot of that – may write about that soon). My success will determine the happiness of people who are so dear to me. I can’t afford to let them down.

Blogging all this is so cathartic. So motivating. So mind-clearing.

More on this so-called important final year exam.
We, and by we I mean the other carbon-based life forms that are my class fellows, have been given 5 months to prepare for our final exam. These 5 months, when we don’t have classes and are free to study, are called the preps. These 5 months started on the 25th of March. It will end on the 25th of August. It is now the 3rd of June. So we’re bearing in on the half-way mark. In the time since the preps started, I’ve done about 4 weeks of prep-mode studying. The rest of the time has been spent in an exhausted, depressed haze where I got heartily sick of the books and was just feeling like crap. On the days when I worked, I worked hard. I clocked in about 8-10 hours a day of pure, hard concentrated study. However about 10 days of a week of such study, I’d break down for a week or so and do nothing but mope around and feel sorry for myself, wondering why I lost the spark of competitiveness that once defined my personality, wondering why I was such a loser, and wondering other things from my large assortment of imaginative ways to beat myself up.

I was smart though, and I started my preps earlier than most of the class. I had gotten around to not having to take my last clinical rotation and used that time to study instead. Clock 2 more weeks due to that time. That makes a total of 6 weeks of hard study. Considering that the preps are in their 9th week so far, that’s not bad going. I know many people much, much worse off.

I haven’t studied much at all these last 2 weeks. I got sick of studying (yet again) and just stopped. I finally freaked out and decided to start this blog, as a sort of public self-commitment statement.

Writing all this stuff out so far has cleared my head and helped to get things into perspective. Whereas only a few days ago I thought I was suffering from a total disinterest in my field, writing my tribulations out has just made it clear that I suffer only from the exhaustion that all students with so great a work-load feel from time to time. I let my doubts over my profession feed my exhaustion, and for a while, I was seriously considering leaving medicine after this exam!! Talk about escapism! Talk about running away from your troubles! God, I sure did lose it there for a while, didn’t I?

Wow, so far I’ve written 3,000 words on my second blog post. Have I got something to say, or have I got something to say?

i've actually read your whole blog cuz i have no life. i'm curious as to why you choose to go to Peshawar for med school instead of Islamabad, Lahore or Karachi.
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Recent med school graduate from Peshawar, Pakistan. Started blogging when in throes of final year exams. Currently studying for USMLE Step 1. Aiming for the 2008 Match. I blog about my studies, my worries, and my thoughts on life. I live in Islamabad.

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