FAQ: Ryan’s Residency Pursuits


Ryan and I receive many questions about his residency application process, and we thought it would be helpful to consolidate some of the most frequently asked questions so people can reference them moving forward. Okay, it is mostly our parents and family that seem to come back to the same questions repeatedly, but maybe this can help others understand this complex process, too. Because it is more complex than simply applying, interviewing, and signing a contract. So don’t feel bad if you cannot keep all of it straight the first time through, but also keep this handy the next time you get confused.

What is medical residency?

Residency is graduate medical training following completion from medical school for physicians. Residencies range from three to five years in length, depending on the specialty, and some specialties require subsequent years of fellowship training. Residents are minimally paid because they are not yet fully licensed physicians and are still under supervision of attending physicians. Because doctors are huge fans of acronyms and abbreviations, they have designated each year of residency as a PostGraduate Year (PGY). Therefore, doctors in their first year of residency are referred to as PGY-1’s, doctors in their second year of residency as PGY-2’s, and so on (this is relevant later). Also, the name of the shared application system for residents is deemed the Electronic Residency Application Service or ERAS.

What residency is Ryan pursuing and why?

Ryan is pursuing radiation oncology because it offers a magical blend of his previous MRI research, engineering education, and desire for quality time with patients. My favorite description Ryan made to describe radiation oncology to non-medical folk is that it is zapping cancer with lasers. The specialty is much more complex, and we can go into details about that some other time.

How many years of residency are required for radiation oncology?

Five years.

What is the process for applying to residency?

The process for applying to residency actually begins after the second year of medical school when students study for and take the USMLE Step 1 exam. This standardized exam is an important indicator of specialties that a student can or should apply to since some specialties have different suggested score requirements.

Starting in the summer after the third year of medical school, students begin compiling letters of recommendation, writing a personal statement, and completing the common residency application in ERAS. Through ERAS, students can select the programs they want to apply to and monitor interview invites. The applications are submitted in mid-September. Some time in the fall, students also take the USMLE Step 2 exam, which is more clinically focused than Step 1. While this score is typically less pertinent to residency applications, students should do as well or better than the score they received on Step 1.

Radiation oncology is one of a few specialties that has a separate first-year (PGY-1) requirement. This means that students pursuing this specialty must apply to a series of one-year programs in medicine, surgery, or what is called a transition year (TY) in addition to applying to radiation oncology programs.

As soon as the applications are submitted, students are technically able to receive interview invites. Specialties vary in how quickly they send out interview invites and when the interviews are scheduled, but most specialty interviews take place in December and January. After interviewing, students and programs must rank each other, with students submitting their rankings by mid-February. On Match Day in mid-March, students learn where they matched for residency.

Wait, Ryan has to apply to two types of residencies? 

Yes, Ryan must complete an internship year prior to beginning his residency in radiation oncology, meaning his first year in radiation oncology residency will actually be when he is a PGY-2. Ryan will most likely be at a separate institution, potentially in a completely different area of the country, for his first year of residency than his subsequent four years of residency in radiation oncology. There is only a small number of residency programs in radiation oncology that have an attached intern year at the same institution.

Of the one-year programs Ryan applies to, he can choose between a preliminary year in medicine or surgery, working alongside internal medicine or surgery residents, or a transition year program that is basically a toned down version of a preliminary medicine year with stereotypically less strenuous workdays and more flexibility for electives. The applications and interviews for PGY-1 programs do not impact his applications and interviews for radiation oncology.

How many programs does Ryan apply to and interview with?

Ryan applied to around 60 radiation oncology programs and about 15 PGY-1 programs. Ryan will likely interview with 7-10 radiation oncology programs and 5-10 PGY-1 programs.

Where is Ryan applying to residency programs?

For his intern year, Ryan applied to several first-year programs within the Chicago area to increase the chance that I have at least one more year at my job with a more stable income. However, some of the radiation oncology programs he applied to do have a built in intern year at their institution, which may require us to move sooner rather than later.

Ryan applied all over the country for radiation oncology residency. Because radiation oncology is a more competitive specialty with fewer residency spots available, students are encouraged to avoid limiting themselves to one area.

How does Ryan know which residency he secures?

After submitting his residency rankings in February, Ryan must wait until the middle of March to learn of his fate. All fourth year medical students find out at exactly the same time on the exact same Friday where they have matched for residency. They find out the Monday before if they have matched at all. The reveal of which residency students match to is called Match Day, and I already wrote a significant amount about it here that you can refer to as a refresher, if needed.

Well, that’s all for now. For those of you paying attention, we will be getting married between the time Ryan submits his residency rankings and Match Day. Hopefully it helps to know that we will be committed to each other no matter where we end up. If you have any other questions, just let us know!

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Away Away (Rotations)


The beginning of Ryan’s fourth year of medical school was dedicated to radiation oncology, learning the fundamentals and auditioning at various programs. Students are encouraged to partake in away rotations, which consist of working as a visiting student in other hospitals, if they are pursuing a more competitive specialty (i.e. one with fewer residency spots available). Away rotations offer students the opportunity to test the feel of other programs and showcase their skills and dedication to pursuing the specialty.

In addition to a four-week rotation in radiation oncology at his medical school, Ryan participated in three away rotations. This led to him being gone for almost two months (there was a two-week away rotation in Chicago in the middle), contributing to our longest time apart since we began dating. We survived, though I am not sure long-distance is something I want to try again soon.

Each program held different expectations for Ryan regarding workload, with some requiring medical students to only conduct new patient consultations and others expecting medical students to share the same daily tasks as the residents. With most assigned patients, Ryan conducted a history and physical and helped plan radiation treatment with a resident and the attending. Ryan preferred having more to do throughout the day but took advantage of the rotations that assigned him less patients at a time to more thoroughly research different kinds of complex cancers. It was exciting for Ryan to finally get to work in his chosen field of medicine and validating for him to enjoy working in the radiation oncology clinics.

Beyond being an opportunity to learn more about the field, the away rotations are essentially extensive interviews with huge implications for where we can be for Ryan’s residency. Establishing a positive impression during the rotation goes a long way towards programs later ranking you highly in the match process if they feel you will be a good fit in their program. From small social interactions to presentations given to the entire department, Ryan was constantly auditioning and feeling the stress associated with trying to impress.

Two programs officially interviewed Ryan for a residency spot during the rotation, meaning he took time away from the clinic to meet with most of the attendings associated with the residency program. The other two programs will be interviewing Ryan later this winter at the same time as other candidates because their policies do not allow for interviews to occur during the away rotation.

Meanwhile back at home, I sometimes struggled to make my travails walking the dog or doing laundry sound interesting following Ryan’s experiences in and out of his away rotations. Throughout the away rotations, he was also exploring new cities and places that we will potentially live. It was not a vacation, but there were definitely moments that offered him a real escape from the daily minutiae of living at home.

We made sure to talk on the phone everyday, often late at night for one or both of us due to time zone differences, and we threw in a few FaceTime sessions, which Lana seemed to appreciate (or be utterly confused by). My introverted self allowed at least one social outing per week (I think one week I even had two!), so that offered some fresh fodder for discussion.

But time apart was hard for both of us in different ways. It does help highlight some of the small things we take for granted with each other, from who makes the coffee in the morning, to companionship on dog walks, to having the oven preheated for dinner by the time you get home from work, to small tokens of affection, and much more. It gave me a great excuse to put wedding planning on hold for a while, and now we both feel some of the stress of trying to catch up and make some of those major decisions.

Ryan came home full-time in October and jumped immediately into studying all day everyday for the USMLE Step 2 exam. He survived, and now the overarching stress is waiting for interview invites and preparing for all the travel to come in the next three months. Oh, and the wedding planning.

It seems many still get confused with what his residency application and match experience entails, so please stay tuned for an FAQ post heading your way.

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Book Review – When Breath Becomes Air by Paul Kalanithi

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As Ryan travels for his away rotations, I find myself enjoying plenty of reading time. On his recommendation, I recently read When Breath Becomes Air by Paul Kalanithi, a powerful memoir of one man’s transformation from student to doctor to patient and his struggle to answer how we find meaning in life, death, and illness.

Paul was in his final year of neurosurgery residency, one of the most rigorous and prestigious medical specialties, when he was diagnosed with terminal cancer. The book is split into two sections, before and after he receives his diagnosis. In Part One, Paul chronicles how his quest to discover what makes life worth living eventually leads him to pursue a medical degree and neurosurgery residency. After receiving his diagnosis, Paul allows readers to experience his frustration and loss and observe his battle to find meaning for himself through his responsibilities as a doctor and husband.

When reading, my feelings towards Paul fluctuated rapidly – awe and respect at what he could do with his mind and his hands as a neurosurgeon, frustration with his choices and what I deemed to be his inflated ego, guilt at feeling the right to judge this man who very much earned his right to have a big ego, and of course sadness, grief, and despair for him and his family having to live through such a tragic experience. 

These instinctive emotional responses do not surprise me, and I imagine many readers will circulate through similar if still subjective emotional reactions initially. The real power of the book comes from the deeper, existential takeaways that any reader can experience if they are willing to embrace it. It may not be an easy choice for, as Paul mentions, we live in a culture that shies away from mortality, grief, and death. Maybe it was easier for me as someone who has experienced my own deep personal grief (or maybe that is just my inflated ego). 

For medical students, residents, attendings, and hospital personnel, I expect mixed readyness to challenge the cultural narrative that often dehumanizes death and encourages us to deny and move on. Hospitals are the birthplace and death bed of many, the origin of physical triumph and tragedy for many more. It is a constant challenge for those in medical professions to actively humanize each case, each patient, each person that they see. The pull to get through the day, the invasion of personal and seemingly selfish thoughts (If this person’s situation is worse than we thought, the surgery will be inviable and we can go home…please let it be worse than we thought.) is the instinctive response. Doctors must choose, over and over again, to confront this. No one can do it perfectly, and this facet of human fallibility is so well captured by Paul that even those far removed from illness and medical professions can appreciate and hopefully integrate this meaning for themselves. 

The instinctive reaction to judge Paul for his choices (How can you consider continuing to work those long hours instead of embracing the time you have left with your loved ones?) poses a parallel challenge to the reader. It is okay to have those thoughts, it is natural and expected. It is what you subsequently do with the thoughts that holds the greatest power. 

I believe that this book was not written to justify Paul’s choices or even to memorialize them. It is to outline the vastness of a life transition that destroys the future you envision for yourself, as we all are in the practice of envisioning our futures, with the destroying capacity of a nuclear bomb. That path, that vision you have worked for years to build is gone, and you must go a completely different way. And not a way that may rejoin with that old vision, but a way that you are certain will never come near what the original vision represented. 

Paul effectively uses his choices and experience as a way to humanize what so many go through and what we often keep pushed back from our minds because it is too difficult to consider. Sure, I initially judge his decisions because they differ from what I imagine I would do in the same situation. That simply cements that I am not Paul, that I am a different person with a different complex network of values and visions for myself. And of course I am!

And there, hopefully for many readers, lies the true beauty. This book offers you the opportunity not just to gain insight of someone’s experience with and acceptance of mortality but for you to gain profound respect for the inevitable relationship we all have with mortality and how we can choose to face it. 

For those in the medical profession, I believe it offers excellent guidance and encouragement to bring greater humanization to the medical world. A world that tries to build its foundation on science but must also make room for human imperfection, emotion, selfishness and capacity for selflessness. Meeting a patient where he is, understanding his fears, hopes and values, and melding this information with scientific fact and statistics. Knowing that it is not the length of life but the subjective quality that one judges one’s life to have that serves as a legitimate basis for judgment and decision-making. 

In radiation oncology, Ryan will encounter patients who must make decisions that can dramatically alter their quality of life, and he knows he is accepting an emotionally challenging role, to blend his responsibility as a medical expert with the opportunity to support others through significant, and at times irreparable, life transitions. I hope I can support him and push him towards the challenge of treating each case, each patient with personal care. It is so hard, and no one can do it perfectly, but I feel immense respect for anyone choosing to accept that challenge in the first place (and continuing to take it on day after day).

How do you choose to relate to this book?

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(Belated) Third-Year Finale: Internal Medicine


We survived and Ryan officially completed his third year of medical school after an arduous two months in Internal Medicine. The rotation consisted of two four-week blocks, one at the VA Hospital and the other at the main academic hospital. Grading consisted of the usual subjective evaluations, an exam with a standardized patient that included a needle-in-the-haystack selection of free-response text questions, and the notorious National Board of Medical Examinations (NBME) Shelf Exam for Internal Medicine.

Ryan’s days began at 6 AM. His first task of the day was getting “sign out” from the overnight residents that were taking care of his patients. Ryan then completed two to three hours of “pre-round”, which involved going through new results (labs, imaging, notes from consulting services) and seeing the patients. Medical students were typically responsible for two to three patients.

Depending on the attending, formal rounds began between 8 AM and 10 AM and lasted two hours. Throughout the rotation, Ryan did not work with an attending for more than two weeks at a time. Each attending has a different style, so he felt consistently challenged to adapt quickly to each attending’s preferences.

Additionally, the duration and content of rounds varied dramatically between attendings. Some preferred to walk around and discuss each patient outside of his or her room before the entire team sees the patient together, while other attendings preferred to sit in the workroom and discuss all of the patients before walking around. Some attendings let the students give complete presentations, while others tended to interrupt and make the presentations more conversational. Thus during rounds, medical students might present all or some of their patients to the team, summarizing their reason for admission and hospital course, reporting labs and imaging findings, and suggesting plans for management and possible discharge.

Ryan spent the rest of the day following up on tasks assigned during rounds and admitting new patients. On days when his team was not designated to be late admitting, Ryan typically left in the mid to late afternoon.

Ryan’s experience with rounds was similar at both the academic hospital and the VA, but the process of admissions differed between hospitals. At the VA, there was a rotating schedule for when each team was responsible for admitting. This made the hours more predictable, and Ryan liked having a good idea of how the day would be before it began. At Loyola, teams are always admitting unless they are at the maximum number of allowed patients. This made the workload at Loyola less predictable, as it often depended on how many patients had been discharged the day before.

Overall, Ryan enjoyed finishing up his year with Medicine. Compared to Surgery, he had significantly more time during the mornings to prepare for rounds and read up on patients, which helped to reduce stress. Ryan found the most frustrating aspect of Medicine to be the constantly rotating attending schedule because it was difficult to establish a good daily workflow and made the day-to-day anxiety higher than it otherwise might have been.

And so, the mayhem of fourth year begins. Ryan has completed his away rotations at Utah and Northwestern and begins his last away rotation in Michigan today. More on that later.


Posted in Relationships

Glimpse of the Future


I would like to take a moment and note just how much is supposed to happen during Ryan’s fourth year of medical school. The excitement about the next year is pretty equally shared between our getting married and Ryan matching to a residency program. Here is the breakdown of Ryan’s schedule:

Radiation Oncology in Chicago – 4 weeks, July
Radiation Oncology in Utah – 3 weeks, August
Radiation Oncology in Chicago – 2 weeks , August
Radiation Oncology in Michigan – 4 weeks, September

This brings us to October where Ryan is taking the month off to study and complete Step 2, which includes both a written and an oral exam that are taken on separate days. Step 2 assesses students’ medical knowledge and ability to apply clinical skills to patient care with an emphasis on health promotion and disease prevention. This builds off of Step 1, which focused on examining students’ understanding of the basic scientific concepts underlying the practice of medicine. After Ryan completes Step 2 in October, we make a brief escape to The Happiest Place on Earth.

During November, December, and January, Ryan is based in Chicago but will be traveling frequently for residency interviews. Ryan is hoping to apply to around 60 residency programs that will potentially result in about 30 interviews located across the country. I will attend a bachelorette party in November, and Ryan attends his soirée in January. We can also throw in a couple bridal showers somewhere in these months and Christmas in Florida.

February, of course, brings the wedding in Colorado. May there be plenty of snow, safe skiing, and safe travel.

Match Day comes in March followed by whatever celebration and fallout it may bring. April often consists of the initial job and living search in the place we matched, if needed, and medical school graduation is in May. Our hope is to take a nice long honeymoon after graduation before dealing with any packing, moving, and whathaveyou. Ryan will begin his residency in the beginning of July.

That is a lot of change and eventfulness, and hopefully most of it will be positive. Already in his first radiation oncology rotation, Ryan may have longer days than he first anticipated, but he is enjoying the content of his days so much more than his past clinical rotations. He says the days go by quickly and feel more fulfilling. Ryan experiences significant anxiety from feeling like he is constantly having to audition in his chosen specialty, and he uses it as fuel for motivation and working (really) hard. I cannot emphasize enough how amazing, reassuring, and gratifying it is to see him doing what he wants to do and actually enjoying it.

I am in a much more stable and fulfilling position myself at my new job, and I hope this serves to make me a more reliable source of support and less of an additional stressor while we both go through this whirlwind year. The weeks apart will be difficult, and I am hopeful that we will still attend to each other from afar.

The body’s physical response to anxiety and excitement is the same, and we must use this to our advantage. As nervous as we might be about the future – Match Day, reciting vows in front of an audience, traveling – there is valuable excitement interwoven in each of these events as well.

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Surgery Part 2: Burns

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Ryan spent the second month of his surgical rotation in the Burn unit. Patients that end up there may have standard burns or electrical burns, but patients are also sent to this unit for skin and soft tissue infections that can fester in a most foul-smelling manner.

Patients from all over the Midwest are brought to this burn unit for higher levels of care. Many of the patients have sad, traumatic stories about how they were burned. From house fires, car crashes, work accidents, and child abuse, Ryan understandably found this aspect of the month emotionally exhausting.

Ryan was surprised to find out that the burn unit is also responsible for wound care for patients with horrific bacterial infections. The smell of necrotizing fasciitis (essentially rotting dead flesh) is one that will not soon be forgotten by him or any of the team members. These patients were often morbidly obese and had multiple medical conditions that complicated and prevented their bodies from fighting off the infection properly.

On Burns, Ryan was lucky enough to sleep in until 4:30 AM on most mornings since rounds did not start until 7 AM (as opposed to 6 AM on Surg Onc). The schedule for divvying up OR and outpatient days was similar to Surg Onc, yet Ryan found himself less interested in these surgeries compared to the prior month. After seeing some of the most “incredible” abdominal procedures during Surg Onc, Ryan found the Burns surgeries a bit repetitive and less impressive.

Surgeries in the burn unit typically followed the same pattern. First, the wounds were cleaned out and the dead tissue removed. Once the patients were stabilized and the wounds were properly cleaned, they would get skin grafts. This process involves essentially removing a thin layer of skin from a healthy area of the patient via a fancy potato-peeler-like mechanism and transplanting it over the burned skin or previous areas of infection.

A patient’s stay in the burn center consisted of multiple trips to the OR for repeat cleaning and grafting. The patient would remain in the hospital until it was clear that the grafts were viable and the patient could tolerate the pain. While it was very interesting to gain a better understanding of the surgery process, the repetition and foul smell made the surgeries lose their luster for Ryan over the course of the month.

The team dynamic during this month was a little smoother than on Surg Onc, although there was still some frustration regarding communication (or lack thereof). That seems to be an ongoing theme of the third-year rotations. Throughout Ryan’s month on Burns, three different attending physicians ran the service. Each had their own way of running the unit and taking care of patients, so the transition periods between attendings were often frustrating for the entire team.

All in all, this month was one that Ryan will remember throughout the rest of his career. As a radiation oncologist, he will likely not get to see patients like this frequently in the future. With that logic, he was able to stay motivated and interested in his day-to-day responsibilities even when the surgeries felt repetitive.

Throughout the two months of surgery, one of the biggest challenges for Ryan was remaining positive. Whether due to the sleep deprivation or the stressful working hours, there was always an overwhelming sense of pessimism clouding his mood. Ryan certainly tried to fight off the negativity by taking comments less personally. He figured that as long as he tried to give his best, the criticism and judgments of those around him did not feel as insulting. While the success of this mindset would wax and wane in relation to his general energy level and certain external factors, it is good practice towards a habit that will be useful to him as he moves into fourth-year and eventually residency.

It is definitely harder on the relationship to be so severely deprived of time together on these time- and energy-sucking rotations. Part of me is hopeful that there is only one more rotation until the end of third-year. Concurrently, I recognize that Ryan’s last rotation, Medicine, is also more time-consuming than many of the other rotations of third-year. It will mean another couple of months of fighting for considerate moments together, but there is much to look forward to after that.

At the end of June, we road trip to Colorado to try and make more significant progress with wedding planning. In July, Ryan begins his specialty rotations in Radiation Oncology, which he will continue in various venues for the next three months. Granted some of that includes away rotations that will literally separate us for weeks or months at a time, but there is plenty of time to prepare for how we will make the most of it. I also look forward to Ryan feeling greater passion for how he spends his time in the hospital.

It is a love/hate relationship when medical school becomes the third-wheel to your relationship. It propels you towards a future you both crave while also challenging your stamina, priorities, and motivation. We are being tested, and we are persevering.

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Surgery Part 1: Oncology

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A long time in the making, we are ready to discuss Ryan’s surgical rotation. The second-to-last rotation of Ryan’s third-year, surgery encompasses the epitome of the medical school stereotype – incredibly long hours, never enough sleep, and exposure to a unique medical experience. Students get to work at the bottom of the totem pole in one of the most stressful and fast-paced quarters of the hospital.

The eight-week rotation is broken into two four-week sub-rotations. Ryan chose Surgical Oncology (Surg Onc), because of his related interest in Radiation Oncology (Rad Onc), and Burns, because his school has a well-known burn center.

On a typical day in Surg Onc, Ryan woke up at 3:45 AM to arrive at school by 4:30 AM and pre-round with his postop and consult patients. This included reviewing the chart for overnight events, visiting the patient, and completing a physical exam. For each patient, of which there were anywhere from 1 to 4, Ryan filled in a custom-made rounding template sheet that documented vitals, morning labs, and overnight events. Ryan used the template to present his patient to his residents during rounds at 6 AM.

Days were split between the operating room (OR) and outpatient clinic. Ryan and the other medical student on the rotation alternated days spent in the OR in an attempt to balance exposure to various procedures. There were two distinct types of surgeries they participated in during this month: abdominal cancers (stomach, small intestine, pancreas, liver…etc.) and breast cancer.

Depending on which attendings and residents were in each procedure, the responsibility of the medical student varied from being “first assist” on breast surgeries to watching 6-hour long “Whipple procedures” from a distance. Attendings often took advantage of spare moments in the OR to conduct pop quizzes on anatomy and cancer biology as a way to assess students’ preparation for the day’s cases.

Clinic days were faster paced and consisted of seeing patients for brief visits to make sure their recovery from surgery was progressing appropriately. Although there was less time for teaching and assessments in clinic, Ryan was exposed to a greater variety of patients.

Ryan would typically make it home between 4 PM on good days or after 7 PM on the longest days. Each evening, Ryan read over his cases for tomorrow and reviewed the procedures he witnessed that day. Students are expected to answer questions on the spot during rounds, and these few hours before bed are the only time they have to learn. Ryan vacillated between going to bed between 8:30 and 10 PM.

Ryan encountered a challenging dynamic among his team with an overbearing chief resident that showed little interest in helping the medical students transition into a stressful rotation and had a tendency to shame the students for not knowing more. Gratefully, the chief resident went on vacation for one of the four weeks, putting the third-year resident in charge. He was someone with a genuine, deep interest in helping students learn, and it was useful for Ryan and his fellow student to receive validation that it was not something with them but the chief resident that made the day-to-day tasks more difficult.

For the most part, Ryan greatly enjoyed the exposure to interesting surgeries and the teaching methods of his attendings on this part of the surgical rotation. He witnessed firsthand the collaboration between the Surg Onc and Rad Onc teams and still feels confident in his decision to pursue the Rad Onc specialty.

Meanwhile, this month coincided with my spiral downward in work satisfaction at my old job. It was difficult maintaining motivation for my own responsibilities, and I sorely missed having Ryan to lean on and receive advice from. As I mentioned, Ryan was aware that I was struggling but simply could not offer much time to help. Thankfully things took a more positive turn for me not too far into his next sub-rotation where our story continues. Stay tuned!

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I feel like I owe an explanation for being more removed lately. Maybe I just owe this reasoning to myself, and if that is the case, bear with me. It has been a uniquely eventful year following a somewhat depressing end to 2016 (the engagement being a shining exception). Most of that stemmed from work stress and disappointment due to feeling stuck and unsupported. And I’m finally ready to talk about it.

There is an apathetic hopelessness surrounding those months late last fall/early winter. I felt stuck and could not muster the motivation to take the steps necessary to become unstuck. It is an incredibly frustrating feeling, and I would frequently turn it on myself in self-deprecation. I lost my drive for a lot of things I used to derive pleasure from, reading books, playing games, and writing included.

I cannot report much more detail on 2016 other than to say this vicious cycle consumed my mind for too long. Even my mother, when Ryan reached out to share his intention to propose to me, told him that one reason she was so excited was because I could really use a win right now. And what a win it was, but that is another story that you can reminisce about here.

But coming back to the eventfulness of 2017 so far, I look back on each month in theme. So much of it still feels surreal, even now.

January – Time to Commit

  • Commit to studying full-time for my licensing exam after the holidays. (all month)
  • Commit to the time and place of our wedding, involving a quick trip to Colorado. (mid-month)
  • (Ryan more available than usual on his elective month.)

February – Convenient Timing?

  • Emergency laparoscopic appendectomy. (Beginning of the month)
  • Take my licensing exam with some discomfort post-op but no debilitating, distracting pain. (Mid-month)
  • Take a cruise to the western coast of Mexico with only minor abdominal discomfort. (End of the month)
  • (Ryan more available than usual on his Neurology rotation, thankfully allowing him to be extra helpful as I recovered.)

March – Spiraling

  • I learn that I am licensed (morning) and that I am unexpectedly and immediately considered out-of-network with ALL of my clients using insurance (mid-day). My grandfather passes away (evening). (Beginning of the month, same day)
  • Wedding dress shopping, preliminary rounds, while trying to keep a brave face. (Beginning and mid-month)
  • Crescendo of experiences at work leave me feeling incredibly unsupported and hopeless about coming back from the undeserved hit after becoming licensed. (End of the month)
  • (Ryan much less available than usual due to Surgery rotation.)

April – Let’s turn this around.

  • Use the frustration for good this time, looking for opportunities to become unstuck. (Beginning of the month)
  • Find the wedding dress. (Beginning of the month)
  • Turn in 30-day notice at my old practice. (Mid-month)
  • Accept position with new, hopeful practice. (Mid-month)
  • Reunite with small but significant joys, i.e. playing games and reading. (End of the month)
  • (Ryan still less available due to surgery rotation.)

It is a lot for me to wrap my head around, even now. It is funny to feel grateful for something like emergency surgery, but the timing was truly ideal to still allow for a trip to Colorado beforehand, not fully interfere with my exam, and also allow a trip to Mexico only a few weeks afterwards. (Can you imagine how much it would cost to be lifted by helicopter from a cruise ship?)

I mention Ryan’s availability to highlight another aspect of my gratitude for the timing of my surgery but also to emphasize how hard it was to struggle in March without him. I have talked before about my responsibility to minimize or redirect my needs when our time is so limited. It was not like my struggles were a secret, but I kept (or at least tried to keep) my burdens from overwhelming him, too.

I have not written in depth about the surgery rotation yet, but suffice to say that there is no extra energy for him to give after these long days and too short nights. It is not a slam against him but simply a fact of medical school that these shifts must take place, and I am still more grateful that he could help me when I was physically incapacitated if he could only be there for one.

Somehow, things turned around in April. It is hard for me to accept the credit, as it is hard for me to digest any true compliment. Regardless, the source of so much frustration is receding into nothing. I am moving on.

May will bring a wealth of change as I begin a new job, and as hopeful as I like to be about it, there is still the anxiety that comes with any significant change in life. That does not stop me from seeking small pleasures again, and that little piece alone has meant so much in feeling more like myself again. I truly missed reading. A pastime I needed to give up for the sake of studying at the beginning of the year remained lost for too long as I wallowed and struggled. Seeing myself seek that out again may be a change too small for others to appreciate, but I vehemently relish it.

Ryan sees it, and he appreciates it even while he envies it. It is nice to answer his question (or anyone’s for that matter) of how my day is going with fine or good and it be an honest answer. I am doing pretty good, and I am hoping it will continue to get better. In the meantime, I will enjoy reading and playing as much as I can.

It is human, normal, to go through phases of difficulty. I do not expect it to be rosy all the time. But I lost myself for too long. Of course there is a context to consider, from the troublesome work environment to having less time with my partner, and that certainly played a role in the depth and length of my blue period. But I am responsible, too, and it is up to me to find ways to be myself. It makes our rare couple time more authentic and enjoyable, and I hope to be more proactive with taking care of me and us moving forward with the rest of this eventful year.

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