Clerk's Notes 6: Under Pressure (or the story of how a business degree came at the price of my mental health)

       There's something about this weekend that is making me absurdly happy.

       Maybe it's that my duty schedule is permitting me to sleep in on a Sunday. Or maybe it's that the busy street near my condo is closed to cars, and is currently populated by only happy families riding bicycles and stupid teenagers trying to show each other up with skateboard tricks. Wow listen to me, calling teenagers "stupid" and openly resenting them as an age group. How grown-up sounding!

       Maybe it's that I had the time to go out and get a decent breakfast (pancakes, a sausage, and some iced coffee from McDonald's in case you were wondering). Or that afterwards, I got to watch Gilmore Girls on Netflix while simultaneously practicing watercolor painting.

       I think the magic of this weekend really stems from me finally having the time and space to just work on being myself. See, my rotation in Pediatrics is almost over, I'm done with my MBA (more on that later), and there's two weeks left til my Clerkship year ends. I went on duty on Friday night, which means that I don't have to show up in a hospital this weekend. This is what is known as a "From-Pre" weekend, otherwise known to me as "Time-To-Manifest-Your-Life-Outside-Medicine" weekend. These magical occasions only appear every three weeks. You get only get one of these babies once a month.

       No patients to see. No children to placate. No angry parents to avoid. No Management requirements to work on.

       It's just me. And 36 whole hours to myself.

       Truly, a gift from the Gods.

       What's the big deal over these 36 hours, you ask? Well, in your Clerkship year, you learn early on that time is precious. Wait, that is such a cliche. Let me try that again... Time is gold. Time is petmalu. Time is swiping left. Time is a baby duckling being best friends with a cat.

       You spend so much time in hospitals, and what little time you have left outside of it you have to divide among your family, friends, and significant other/s. So, to a super introverted introvert such as myself, finding some time alone is like finding fresh water in a desert.

       Anyway, on to one important life update:

       I finally got my MBA.

       For those of you who don't know, ASMPH offers a dual degree in Medicine and Masters in Business Adminsitration. Well, it's not so much an offer as it is a requirement, as you can't really refuse the MBA part if you enroll in this school. I was never really interested in the MBA, but no other med school I applied to had offered me a scholarship, and I was really interested in the MD. So I kind of got stuck with it.

       Anyway, a lot of potential applicants to the school are concerned about the MBA classes taking away precious study time for Medicine. To me, the MBA classes in your first three years are really no biggie. Usually they happen once every two weeks, and the entire afternoon is dedicated to studying just that subject. They do take some study time away from Medicine, but I was never really big on studying in the first place so it didn't really matter to me.

       But I believe, as most of the senior students do, that the most difficult part about getting this degree is passing the Strategic Management subject, or StraMa for short. StraMa is the last MBA subject that students will take. It is "taught" during the fourth year of med school, which coincidentally is also your freaking Clerkship year. To pass StraMa, you need to submit a sort-of thesis paper on a company of choice. This paper is proof that you have analyzed its strategic issues, conducted thorough research on external opportunities and threats, pored over every detail of its finances, and come up with a satisfying solution to their problems. 

       Normally, regular business students spend a semester working on just their paper. But for ASMPH students, you have to finish this paper WHILE AT THE SAME TIME PERFORMING REGULAR CLERKSHIP DUTIES. 

       Which means that after coming home from a 36-hour duty, you still need to somehow find the energy and mental capacity to sit and write. You need to make time in between your hospital duties to go visit your company and conduct interviews. You need to spend your PRECIOUS from-pre weekends on working on your paper.

       Trust me, it's a lot more difficult than I'm making it sound. And the stakes are very high. If you fail (i.e. your paper is not complete or satisfactory to the MBA panel), then you end up repeating the course, thus delaying your internship year, thus delaying your taking of the medicine boards, thus delaying your becoming a doctor.

       Anyway, ask any current clerk or intern and they will tell you this StraMa thing is total BS. I mean, it's not BS per se. But having this monumentally difficult requirement coincide with your clerkship duties, that is total BS. 

       And for me, my StraMa journey was extremely difficult. When clerkship started, I'd already gotten to work on my paper using a government hospital in Cagayan de Oro as my subject. When I was halfway done with my paper, the hospital suddenly decided that my study wasn't ethically sound (a conclusion that stemmed from a poor understanding of what a management paper was in the first place). So, around three months before the deadline, I had to start from zero and find a different company to work on. Good thing I was able to secure my aunt's construction firm as a backup company.

       I wrote fast. I wrote hard. I made it in time for the deadline, which I was so happy about. Then came the time for my oral defense. I thought I had done a pretty good job with my paper, my adviser had even said so herself. 

       But apparently the panel disagreed. They said they didn't like the strategies I wrote. They failed me and asked me to revise and re-defend the paper in one month.

       Some context: most people pass after their first orals. People rarely ever get a re-orals. 

       But I did.

       I'm not the brightest student in the world. Nowhere near the brightest in my class. But I'd say I'm pretty darn smart, and a good writer at that. I'd never really failed anything before. This re-orals thing was a first, and the unfamiliarity with this new terrain caused me to spiral into what I can only describe as a cycle of depression. 

       I cried so much. Couldn't sleep well. Couldn't be happy. Had so much difficulty getting out of bed in the mornings. Couldn't make the necessary revisions I needed to make because I was in such a horrible mental state. Meanwhile, I was seeing batchmates passing their defenses left and right. Celebratory posts on Facebook. Me hating myself for not doing better. Me blaming the panelists for being too strict. Me hating myself even more for even trying to assign blame in the first place. Cue the vicious cycle of blame, self-hate, guilt, unproductivity, more self-hate due to the unproductivity. Compounded by constant tiredness from my regular clerkship duties. Compounded by the constant threat of delaying my internship year. And the need to keep up the appearance that I was fine, that I was handling everything so well. Telling my groupmates I was okay. Trying not to show that I was annoyed at every suggestion I was given. To add to my stress, one of my immediate family members got diagnosed with a serious illness and had to undergo a major operation. 

       I was constantly pushing myself to move, move, move, trying to overcome a state of paralysis induced by overwhelming stress.

       Constant pressure to work, work, work. Constant anger at myself for being unable to, constant disappointment for the times I could only cry. 

       Constantly trying to drown out the inner voice in my head telling me, Your deadline is in 7 days and here you are, crying like a baby. You're so weak. You're so stupid. You're going to fail. You're so much dumber than you thought you were.

       Trust me. I would not wish this kind of stress on my worst enemies. (Not that I have any enemies, but if I did, I would not wish this on them.)

       Anyway, I was able to trudge my way through that depressing time, with much assistance from my family and friends. Rap, my boyfriend, was the one who really sat with me during my numerous mental breakdowns. I'd tell him that I felt like no matter how hard I worked, I was destined to fail. He would encourage me to work and I'd tell him there was no point in working because I knew I was going to fail, fail, fail. 

       "You can do it," my friends would tell me. "You're going to pass for sure." Internally, I would think that's what you told me the FIRST time, and yet I DID fail, and now I'm inclined to believe that anything you tell me about myself is FALSE. 

       There were days when I'd get home from a long duty and fight back tears as I flipped open my laptop and got straight to work on my paper. Rap was there, giving me coffee and tea and snacks. 

       There were days when I'd break out in tears in the middle of working. Rap would tell me to stop, and invite me to take a walk outside. Then we would grab some ice cream, chat for a bit, and when I got back home I found that I could muster up the remaining dregs of my lifeforce to continue writing.

       And in the end, I finished it.

       Submitted a paper. Defended that paper. Got an MBA that I never even wanted.

       And honestly, at the end of it all, I don't feel particularly proud to be an MBA degree holder. I just feel relief that I'm done with all this BS. I'm relieved that I survived all the mental and emotional trauma with my ego  and body intact. I do believe all the stress had pushed me to the brink of doing something I would have very much regretted later on, like harming myself or quitting med school. And if I didn't have the social support systems that I did, I would have definitely been pushed off that brink. 

       Being a med student is seriously dangerous to one's mental health. Having the MBA on top of that is even worse. 

       I don't want anybody else to go through what I went through. I hope that for future batches, this StraMa requirement is moved to NOT clerkship year because it is just DAMN unhealthy to juggle two huge ass responsibilities at the same time. 

       But at least, at the end of it all, after all the suffering, I can honestly say that I am stronger for it. I still do hear that inner voice calling me stupid and dumb. Except now, I can list some very rational facts that allow me to assert that I, in fact, am intelligent and great.

       My paper is complete, down to the last financial details. My revisions were excellent. My strategies were on-point. I wrote all these, and dealt with a family member's illness, without ever having to skip work or miss a duty. I was humble enough to ask for help when I needed it, and strong enough to power through the rest.

      And in the process, I learned a couple of things about myself: I have a good support system. I am resilient. I am capable. I am tough.

       And no panel can ever take this away from me.