“You’re Not My Homeland Anymore”

Or “So I’m Leaving Out the Side Door” Part Two

Since this post is a sequel to that one, I’m posting the lyric video again.

In “exile” from folklore, Taylor Swift and Justin Vernon of Bon Iver are singing to and about an ex-lover. For me, the song has taken on a totally different, personal meaning.

It’s held steady as my favorite song on folklore (with many others way, way up there, at this moment the next closest has to be “the lakes”) because the whole concept of exile seems to fit my life right now. Even if it’s (semi) self-imposed.

For me the you of the song isn’t an ex, isn’t a lover, isn’t a person at all.

It’s medical school. It’s medical training as a whole. It’s the medical education industrial complex.

“So I’m leaving out the side door”

I’m leaving medical school.

It’s official now, so I can say it out loud instead of all those cryptic allusions to such huge life upheavals and transitions and going through something life-changing and experiencing extreme emotional turmoil. It was all about leaving medical school.

There’s so much to say about this seismic life change. This post can only get to a tiny fraction of it all.

“second third and hundredth chances
balancing on breaking branches”

The natural first question, I’m sure, is why. That too feels huge and like I can only scratch the surface at first post. It mostly boils down to disability, and not being superwoman. 

I was the first, and so far only, person in my medical school with a visual disability. A lot of people called me a “trailblazer” and said I was “finding the holes in the curriculum,” and I’m sure they meant it as a compliment but the truth is that the burden of all that trailblazing was impossible to shoulder while also learning medicine.

Just to have access to much of the curriculum, I had to brainstorm, create, pitch, come up with implementation plans, advocate, coordinate in endless meetings and emails, push push push push push for the infrastructure for them to teach a student like me. And I was often met with all the reasons whatever solution I came up with wouldn’t work. I had to invent everything from scratch and then scratch through concrete with bare hands to try to get anything put in place. And that was all on top of the demanding, all-consuming role of medical student.

It was like I had to be two people at the same time, all the time. It was coming at way too much of a cost, especially in hours per week I had to spend being an unpaid advocate/coordinator/admin type person, just to keep my head above water.

I was always drowning, in a way that had nothing to do with med school material, but was still drowning just the same.

It was looking to get exponentially worse with impending clinical rotations, in which my time would get dramatically less available. And I knew it wouldn’t end with rotations, that this would extend into residency as well. I could look to years on end consumed in scratching tooth and nail for access and banging my head against walls. Years.

This is a career path that breaks people who have every advantage, and I don’t in many ways outside of just disability. I could see myself breaking under the double burden of student and trailblazer. This just wasn’t how I wanted to live my life.

I have some feelings about whether my school should have admitted me; I was unquestionably qualified but they just didn’t have the structures in place for a student like me, at all, and I would’ve preferred not to spend, you know, two years of my life and an unspeakable amount of student loan debt figuring that out for them. Yeah, I’m a little bitter about the situation. And may be for a long while. Maybe forever.

It has burned me out in such a short amount of time. To the point that too many lines have been crossed and I just want OUT. I don’t think there’s anything anyone could say that would make me want to stay anymore.

So, as I wanted to sign off the letter I wrote to initiate the leaving process but didn’t (of course), peace out motherfuckers.

“I gave so many signs”

I tried, so many times, to tell people what was going on, and how unsustainable the situation was.

Mostly, I got told I was making a big deal out of nothing. I wanted to scream, and count out all the important battles I hadn’t even picked out of survival and necessity, and start keeping timesheets of all the work I was putting in and what extreme amounts I had to invest to get any movement on anything.

I got told that since I wasn’t failing academically, that accommodations weren’t important (the academics weren’t the issue, I know how to school and school well). As if the ADA, Section 504 of the Rehabilitation Act and the whole concept of equity only apply if a person is failing, and if they’re not, well then access issues be damned.

I tried to start serious discussions about how bad things were, several times. Including once telling someone directly that I wanted to leave and why, and got told that I was just stressed over boards. The access issues started as early as orientation week, so I kind of feel like I’ve been screaming and screaming for the last two years and no one has heard me.

Some people would respond to things I brought up with the attitude of “Well, it’s this bad everywhere,” which maybe I would’ve believed if I were younger or had less experience. But I’ve had a lot of jobs, and I’ve gone to a lot of school, and it’s never been anything like this nightmare.

I do think it’s a systemic problem in medicine, as other blind and visually-impaired friends in medicine have had similar experiences, and at a conference on disability in medicine a couple months ago, I saw how universal this experience. As one friend said, “I never felt so disabled as I do in medical school.”

There’s also a surprising amount of ignorance within the medical profession about disability, like nothing I’ve encountered in decades, which is concerning for a lot of reasons.

I want to be clear though, that a lot of the people I worked with closely were great. It may not sound like it from some of what I’ve written, but there were a lot of people who saw it and got it, but maybe didn’t have the ability to do anything about it or the authority to change things. I think some people who were working with me may have felt really helpless in the face of all the insurmountable and immovable obstacles.

“I think I’ve seen this film before”

This isn’t the first time I’ve left a career path because of disability issues. And still, I didn’t think it would happen again. The first time, the times were different (early ’00s) and my abilities to advocate or to know that I could were mediocre at best. I gave up at the first drop of a professor not wanting me in his class, without really understanding that that was motivating my actions.

This time, I thought I knew better. I thought the times were different. I thought it would be hard, but doable. I’d had a great experience as a pre-med, at least in the school aspect of it (not so much in MCAT accommodations or finding clinical jobs) and this time, I knew so much more about my rights and how to advocate.

And I knew there’d been others before me–very few in the country, but some–and I thought if I was pleasant enough to work with and as adaptable as possible, that it would go okay. But then I was adapting in ways that just couldn’t be sustained or translated into the clinical phase, and ways that absolutely burned me out.

So, here we are again, with the career crumbling.

exilevideopic

“you were my town
now I’m in exile seeing you out”

Leaving medical school, feels huge, sometimes unbearably so. It feels like a divorce, or more aptly, like a death.

This career was something I started working toward in 2007. That’s thirteen years of my life. That’s the loss of this clear plan for my future that I’ve held for so long. The loss is devastating.

And it feels like it’s my choice but not my choice at the same time.

I really thought I’d found my thing, my calling, after being listless for a lot of my twenties, and it’s hard to give that up. It’s hard because I found, through my pre-med years, that I really freaking love science. And I’m really freaking good at it. I thought medicine would be my way to merge that love and talent for science with a love of working with people, which all my former jobs point to.

I had doubts along the journey, sometimes a lot of them, because I don’t think anyone, if they’re thinking about it deeply, takes on that much debt and this long and demanding training without having doubts, but despite the doubts I thought I had found my place in the world.

It’s hard to see that thirteen-year dream die. It’s hard to feel listless again. It’s hard to give up a prescribed path of medical school (didactics, Step 1 exam, clinicals, residency applications, interviews, Match Day and all the other standardized tests, shelf exams, required projects, and core rotations along the way at their ordained times), residency, fellowship, practice. It’s hard to give up the comfort that a prescribed path provides.

I’m in deep grief, going through waves of all the stages of grief, especially anger. Sometimes, I feel so bad for not being able to live up to other people’s expectations of me to represent them, to never stop fighting, to be the magical disabled person. But I’m not. I’m just a human who wants a life she can live with.

It’s probably going to take awhile until I’m okay again. For now, I’m just not, and in a weird way I struggle to explain, I’m okay with not being okay.

This feels huge and catastrophic–The Tower–and along with all the rage and grief and dying dreams and abject terror about how I’m going to survive my future now, there is also tremendous relief, to the point of celebration and wanting to scream from the rooftops that I’m GTFO. There were little voices saying maybe this path was never right for me–there was a part of me that knew all along–and in that way, this change feels good. Or rather, it feels like it will eventually be good. But mostly, now, it’s all death and The Tower and crisis and grief and rage and murky confusion.

Oh yeah, and then there’s the financial ruin piece of it. Financial aid for living expenses was my income, so I’ve lost that, and am now in so much student loan debt I’ll probably never pay it off. Which, like, welcome to America, right? Who isn’t in that boat these days, but the expense of medical school means that my student loan boat is bigger than most.

I’m grappling with it all. I don’t care a ton about money, but I do care a lot about security. To know that it’s likely that I’ll never get out of that debt, never get ahead, never make up for not having been able to save for retirement in my earlier years (I thought I’d be able to do that with medicine, even though the specialties I was interested were on the lower-paying end I knew I could eventually, after residency and fellowship, live simply and save like crazy to make up for all the lost time) is, to use a medical metaphor cliche, a really tough pill to swallow.  So, there’s a lot of grief and a lot more fear in this aspect of the fallout of it all.

And those are just the bigger picture worries; there are lots of more immediate ones, like food and shelter and survival. I’m going to have to move when my lease ends, because with no income and all this debt, I can’t afford to stay. Which is like fine because I’m not crazy about this place and a lot of its advantages are moot points now anyway because of the pandemic.

Right now, I’m lost and everything that was once known and clear is all unknown and murky. I need to find a new homeland, in terms of a new literal place to live and in a metaphorical way of a new path.

“So I’m leaving out the side door” (reprise)

In the original post, I said I did a thing that day. That thing was sending an email to a dean to initiate the process. It’s now official, and I’ve told a lot of people–professors and other people at the school I’ve worked closely with, student groups I’m working with, my parents. I’ve been telling people since back at the end of February, and it somehow never gets easier. I cry, from grief and rage, every time I tell someone.

But to be clear, that doesn’t mean I’m conflicted about the decision to leave. I’m not. I haven’t been for over six months since I first decided. As I said in my email to the dean, “I write this with a heavy heart but not an ambivalent one.”

I’m starting the process of leaving by going on a Leave of Absence, so I’ll technically be an unenrolled student for about the next year. That’ll start after the end of this current term (Sept 18) as I finish out a one-credit class on diagnostic reasoning.

After that, who knows. In a long term sense, I have some thoughts and ideas, but also recognize that I’m not in the place right now to jump into something new, especially when thinking about long-term career plans.

This whole medical school ordeal, and the stress of having to be two people and two roles all the time, and all the obstacles I faced, along with some things inherent in medical training added up to a pretty traumatic experience, and I don’t say that lightly. I need to breathe and recuperate and get through the worst waves of the grieving and healing.

I don’t feel like I’m in the space to know yet what comes next. I’m just surviving the day, each day, until eventually I can think past just that.

I wanted to put it out there, because I’ve been cryptically alluding to what’s going on for awhile, and because now that it’s official I don’t have to worry about anyone finding out from someone other than me. So I’m just saying it to say it, to be real about what’s going on, because this whole thing is like a black hole at the center of my life.

So, I’m just getting through the day. And for now, at least, that has to be enough.

-April

11 thoughts on ““You’re Not My Homeland Anymore”

  1. Pingback: “So I’m Leaving Out the Side Door” | April Julia

  2. Congratulations :-) You have made the decision that is best for you. Your new direction will come in time and your past efforts and experiences will have prepared you for it.

  3. Brian is right — you should feel proud of yourself. You had the immense courage, strength, and resourcefulness to generate your very own life preserver while everyone else stood passively on the shoreline.

    Although the consequences of leaving are overwhelming, the consequences of staying would have been far worse…you may literally be exiting a situation that could have taken years off your life.

    As Brian said, no experience is ever wasted — and I can attest to that as someone who’s had no less than 5 different careers already and still has 15-20 years (at least) of full-time work ahead of me.

    Even though I’ve borne witness to this wrenching journey from the beginning, I was nevertheless struck by what a powerful and compelling — and heartbreaking — narrative you wove together from all the threads that have extended over this period.

    As excruciating as this experience is right now, you WILL get to the other side of it, and brighter days will come. I’m so excited about whatever you decide to do next, because it will be great. You are a force to be reckoned with, sister.

    • Claire! Thank you for such a thoughtful response! I think you’re right in that staying would have caused more damage in the long run, or the short run.

      Other people have said a similar thing, that the experience isn’t wasted, and maybe it’ll find its way into whatever comes next.

      For whatever reason, I feel more relief and more hope after writing this post than from anything else lately.

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