In a few months, I will be taking the single most important exam of my medical career. What most people don’t know is that getting into medical school is only 20% of the battle into becoming a doctor. Another 20% is remaining a student while dealing with medical school anxiety. Staying in medical school is a means of passing exams, maintaining your passion and eerily, staying alive until graduation. What many people don’t talk about is the declining mental health of medical students. We hear about the study habits, research papers, and white coat ceremonies. Somehow, we omit that 1 in 4 medical students experience depression, a rate two to five times higher than the general population. 11% of medical students admitted to suicidal ideation, a rate triple the amount in the US population. While this is the case, only about 16% of medical students report seeking psychiatric treatment.
Many of our friends and family, view us in this messianic light of the future doctor that has it all together. That couldn’t be farther from the truth. Currently, my laundry is piled upon my bed, I skipped lunch and my heart is racing due to my overthinking.
Sadly, I know I’m not alone.
You thought medical school graduation was the end of it? Not exactly.
Currently, there are two types of medical schools, Allopathic (MD) and Osteopathic (DO) medical schools. The destination of both types of medical schools is residency. To make it to residency, MD and DO students will meet the same fate in the application process to hopefully MATCH. Successfully matching guarantees that you will become a doctor in a specific specialty of choice. Your diploma only certifies that you completed your medical coursework. Residency allows you to treat patients and legally practice as a physician. Without matching, you are essentially a physician by paper but not practice. The MATCH process is basically being selected by a hospital to begin your formal training as a physician.
Now back to the remaining 60% of what it takes to become a doctor: A 3- Part National Board Examination.
The single most important predictor of successfully matching is Step 1 United States Medical Licensing Exam (USMLE). As a DO student, I will be taking the Step 1 exam as well as the Level 1 COMLEX exam to increase my competitiveness. Some students will be plagued with the following questions: What If I fail comlex ? What if I fail Step 1 ? I failed comlex level 1, now what? I failed step 1, now what? The anxiety of the exam build long before even starting to study.
I started actively studying for Step 1 in January 2019. I spent my winter break going to sleep at 4 AM, doing nothing but watching reality TV and being a New York City socialite. On the last day of winter break, I started to get serious as the reality of back to school set in. My Pathology professor recommended that our class use the last two or three weeks of break to begin prepping for the national board exams. This meant doing 500-1000 practice questions to get ahead of the curve. Defiantly, I did not listen. Instead, I took two practice tests a day before starting the spring semester. It provided me with a baseline score as well as what to expect from board-style questions. When I finished the last exam, it was midnight. I took a shower and got into bed. Several moments later, I was tossing and turning in bed. Finally, I looked at the cable box, which said 1:44 AM. Once more, I began tossing and turning. My heart started fluttering with palpitations getting more intense with every breath. I was breathing so heavy that I jumped out of bed to catch my breath. I looked at the cable box, which said 3:00 AM.
Step 1 Anxiety is Real
Once I came to terms that my anxiety had taken over me, I had to do what every millennial does in acute panic; run to social media. I went to Snapchat and told my friends that I was having an anxiety attack. They replied, “why?”. Strangely, I didn’t have an immediate answer to the question. I didn’t consider why I was anxious. It completely threw me off my thoughts of “impending doom”. Now, I had to sit there and question myself.
I realized that I was anxious about the reality of starting school and having to take the most important board exam in a few months. I felt unprepared and guilty about enjoying my winter break. I didn’t create a schedule or game plan. My biggest boards effort during the break was watching Med School YouTubers talk about their Step 1 scores. Anyway, this realization took so long that I forgot to reply to my friends on Snapchat.
I ended up going to sleep at 7:00 AM, only to awake in 3 hours. That morning, I shared a post on Social Media as an outlet for myself and others to not feel alone. Transparency makes me feel better and spreads positive vibes faster than you think.
I am considered the “strong friend” who rarely shows emotional vulnerability. I’m the one my friends call when they feel like their world is upside down and need some comedic relief. I always bring the jokes. Laughter and I go hand in hand.
I understand now that being emotional does not make you weak.
To combat boards anxiety, I remembered the vision board that I keep on the wall of my room. It’s a reminder of the things I have accomplished and have yet to accomplish. I found magazines to cut into a few numbers to plaster my ideal Step 1 and Level 1 score on the vision board. I didn’t find the initial score that I wanted, but instead, I found the numbers for a score of 10 points higher.
I thought, why not aim higher?
Instantly, I felt so much better.
That same night, I started the #morningpersonchallenge which means going to sleep at 11:00 PM and waking up at 6:00 AM.
That night, I slept like a baby.
The next day, I went to class and everything was fine. When I got home, I started working on boards prep material until I got the reminder from my Bedtime app. At 10:00 PM, the app sounds off and tells you that you have one hour to get into bed. From there, I closed my laptop and headed to my nightly shower concert featuring my favorite Beyoncé ballads.
I got into bed by 10:35 PM. Moments later, I was tossing and turning. It continued for another hour or so.
The ugly monster of anxiety started taking hold of me again. My neck and jaw muscles were tight, and my body was inconsolably shaking. I had to get out of bed to take a few deep breaths upwards from the belly to the diaphragm for about 10 seconds.
This helped for a bit, but then I had to consult with the one and only… Dr. Google.
I Google searched “how to get rid of an anxiety attack”.
The search results provided a few important pointers with the most helpful being asking myself if my thoughts were realistic.
What am I anxious about?
Is it really the end of the world?
My mind was racing with preoccupations of family emergencies, board exams, study habits, schedules, deadlines, and inadequacy. Besides stress from school, there have also been family troubles that are weighing heavy on my heart. I’ve also been feeling like a “bad friend” for not following up with people as much. It also doesn’t make it better than my friends make sure to remind me of it anytime they can.
The core of my anxiety stems from being an empath. When you confide in me, your pain becomes my pain. So, it does bother me that I can’t be there for everyone in my life and help them through things. For the most part, I will text you or interact on social media as best I can. Phone conversations take up a lot of my time and leave me emotionally drained. This is most likely due to the transferable energy of empathy.
The Anxiety Attack Continues
Please bear with me and my scattered storytelling. Now, back to the anxiety attack.
An even more triggering task during the attack was saying positive statements to counter my negative thoughts. It felt like something pushing against my conscience to offshoot a mentality that lived there for so long. If negative thoughts are like hard rocks resistant to pressure, positive thoughts are soft rocks that can be easily eroded. Once I started speaking aloud, the positive thoughts aggregated into the atmosphere. Like a cliff overhang, the soft rock eroded and a waterfall of tears fell.
It was like anxiety jumped out of my body when I began crying. A release of tension, discourse, and irrationality was gone.
Release Your Worries
I’m not going to trouble you any further with my rambled thoughts, but what I will say is that crying is therapeutic.
Crying is good for the soul. I’m going to cry a few more times during this medical journey. If you think about it, crying is physiologically necessary. Think about the infant who emerges out of the womb. If the newborn emerges silent, the doctor must slap them a bit until they start crying. This is because crying is a sign of vitality. It means the baby is alive and aware of his or her new environment. As the baby grows into a toddler, they will cry for toys or attention, which is easily controllable. Once that baby becomes a preteen or adolescent, they start to cry less. Then, as an adult, you really don’t cry much, or at all. Unless you reach the brink of anxiety.
Crying is not a sign of weakness. Acknowledging that you’re stressed beyond a normal threshold, is the first step. So often we walk around with pent up worry, emotions, and anger that we fail to accept. Always Keep Fighting. You shouldn’t suffer in silence. Anxiety in Medical School is real. Please reach out to your friends, family, physicians, and religious sanctities. Lately, I’ve been self-reflecting more, praying more and still, crying more. The release from my system is immediately gratifying beyond belief.
I’m in med school and I’ll cry if I want to.
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