Before I left Boston a few hours later, I changed out of my suit and into jeans and tee shirts. Some friends, The Beau, and I met up at a mall that was clearly designed in the 1970s. The Beau had thoughtfully purchased a Vietnamese sandwich (banh mi) for me; I purchased a cookies and cream milkshake.
We didn’t talk about the exam too much. My friends are sensible people.
By the time I got into the Bolt Bus to go back to Manhattan, my body was tired and I could not keep my eyes open. The sun was beginning to set and the golden orange light flickered through the bus windows. I nodded off, but was thinking, thinking, thinking…
… and, perhaps an hour later, I awoke and noticed that the bus was crawling along with the rest of traffic. Red taillights glowed in front of us in the purple-blue night sky.
The Beau noticed that I had stirred and looked at me.
“There’s a good chance I didn’t pass the exam,” I murmured.
He might have said something in response; I don’t remember. I fell back asleep.
I knew what I had said, though. And while I hoped otherwise, I knew that my statement had validity: There really was a chance—maybe even a “good” chance—that I didn’t pass. Everything that I had done “wrong” returned to my mind as soon as my anxiety had dissipated:
- I hadn’t asked the patient about homicidality.
- I didn’t assess her for eating disorders.
- I could have asked more about her past history.
- Why did the examiners keep asking me about her employment history? Why didn’t I ask her more about that?
- I probably shouldn’t have stuck so firmly to my answers with the vignette.
- He was probably asking more for pharmacological recommendations; why did I address those?
- I didn’t read the vignette as closely as I could. I probably looked like an idiot.
And on. And on. And on.
They had told us that results would be sent in about a month. That gave me one month to distract myself. There was nothing I could do now.
We tend to learn processes as linear patterns, though, in reality, things are interconnected. Some postulate that emotions always follow thoughts (beware of aphorisms that include the word “always”), though we can all cite personal examples of how bad moods can lead to negative thoughts, even about things completely unrelated to whatever precipitated the bad mood.
During particularly hectic or otherwise mentally taxing days at work, I found myself utterly convinced that I had failed the exam and had internal dialogues that went something like this:
“You probably didn’t pass the exam.”
“You don’t know that.”
“This is true, but I missed a few key things.”
“Right, but you didn’t miss every key thing.”
“Fine, but I don’t want to take the exam again.”
“And if you have to take the exam again, so be it! You’ll at least know what to expect.”
“It’s the principle of the thing. I don’t want to spend that chunk of change again.”
“You may not have to.”
“You’re right.”
“I know.”
“But I still feel anxious.”
“I know.”
And then I’d try to think about something else. I used a lot of the distress tolerance skills I had ever learned or taught.
While running early in the morning (only after the exam did I revert back to 5:30am runs), my mind would wander all over this again. The running, though, was therapeutic in its own right in helping to dispel some of the anxious energy.
Ultimately, all I could do was wait. And take comfort that the exam was over. And that I could spend more time doing other things—like write here.
Maria Yang, MD 