Waiting for life to begin

Dr Kerrianne Huynh is a fellow currently working in Melbourne.

I passed the fellowship exam last year.

It was my third attempt at the exam.

Sitting an exam during a pandemic was the last thing I thought I would have to do.

The day of the hot case was strange in its ordinariness. I was wearing my regular scrubs. I was wearing my regular work shoes, 100% impermeable plastic that could be sprayed down with Dettol after a day in the covid pod. But the hospital at which I arrived was unfamiliar.

The exam centre was having construction works. The examiners had requested that there be absolutely no drilling; an unexpected kindness that meant that I no longer had any other external noise to compete with the incessant cacophony inside my head, except the occasional hammer beat.

I did my first hot case. I remember seeing a surgical scar that I wasn’t familiar with. I remember the drain system was slightly different from the one I was used to seeing. One of the examiners was someone I had recently worked with (the lack of interstate travel meant that this was much more likely to occur than in previous examinations). I thanked my lucky stars that my facial expression was partially hidden behind a mask. I remember being terrified that I had failed because of the way I took my PPE off (which, to be fair, had been a previous viva). The second hot case seemed better.

It seemed intensely unfair … and really strange… that so many years of my training and exam preparation came down to a handful of heated minutes.

I was informed of my passing the exam in an anti-climactic email that my husband and I read in our sun-lit living room. We were in lockdown. There was nowhere to go. We celebrated quietly at home.

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I never learned how to deal with failure.

I never learned how to deal with true doubt about my own performance.

I had always been a studious child, who studied often and passed exams. The whole reason I had progressed into medicine was because I was good at passing exams. And then, one day, I didn’t.

In retrospect it shocks me as to how unkind I had been to myself during the exam process, especially regarding hot cases.

Throughout my training, I had been a good registrar. I was trusted and generally well liked. How could these consultants ever trust me again once they saw how stupid I was? How would they ever let me look after patients once they realised I couldn’t string together a simple sentence? In fact, why was I even here? What was the point of practicing? It was hard, hard, hard for me to reconcile that inarticulate idiot with the person that otherwise turned up to work every day, ran MET calls like a pro and told other people what to do. It became harder and harder to get out of bed for exam practice. The persistence of that negative voice got so loud I could almost hear her, and badly wanted to punch her in the face. The problem was, she was also me.

At the same time, I was really worried about the coronavirus. It was not officially a pandemic when I was studying for the exam again. The mood at work became more and more anxious. I was afraid. When our first covid pod opened in the ICU, I wouldn’t let my husband so much as hug me after I got home, until I had stripped down and had a hot shower.

I was worried about him, too. Here he was, an immunosuppressed GP who worked near the airport; the great international gate of covid seemed right outside his door. His personal supply of PPE was so small and pathetic, I made plans to make him a face shield with some sponges and a plastic manila folder from Officeworks.

When the second wave arrived, I made the mistake of not leaving the house for the first fortnight. This, while living in a classic Melbourne shoebox that did not receive direct sunlight for most of the year. You can imagine the effect it had on me.

We were banned from doing hot cases at other hospitals. Then we were banned from doing hot cases at work unless we were on the floor.

I failed my exam for a second time.

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After the second wave, my husband and I made the excellent decision to move to a fifth-floor apartment, full of light and air. I remember visiting the apartment before we had even connected the electricity. We clinked glasses of red wine and watched the stars fill the sky as the city glowed. We adopted a kitten, who, like most cats, seemed to take far too long to decide whether he liked us or not. I made a point of finishing the Couch to 5k again. I got vaccinated, which felt like obtaining a superpower overnight.

Despite all these positive changes, it was amazing how much the exam owned me. My entire life revolved around it. I couldn’t see past it. I couldn’t plan for a future. It was a barrier that loomed large and ever-present. Studying during the pandemic essentially meant that while I could study quietly at home, there was no relief. There was no real break. We couldn’t even meet up to study. It made it hard getting up again after the second time I failed the exam.

It was very difficult to talk about my failure. People were kind. They were more than kind. I talked to some very, very genuine people who shared their own experiences with me. However, I couldn’t believe that failing the exam didn’t change the way I was seen as a doctor. There was still too much stigma in medicine about failure. It is much easier for people to talk about and celebrate success, among a population of people who are historically very successful. The exam medallist that read Oh’s from cover to cover. The candidate who had organised their study group dates 12 months in advance. Wasn’t the pass rate for the second part exam sometimes as low as 33%? Why are we not talking about failure more? I went to almost every exam preparation course in Australia and New Zealand. I cannot recollect a single lecture about what it is like to fail and what to do about it.

I saw a more-than-excellent sports psychologist. We talked about how I perceived the exam as a threat, and that my response to an imperfect hot case was a safety mechanism that I needed to move past. I was preoccupied with perfection. He taught me how to believe in my own competence rather than go searching for a feeling of confidence. He taught me that when it didn’t matter how I felt, that was when I would be ready for the exam.

We talked about that hypercritical voice. A lot. She was, in many ways, still trying to convince me to abandon the exam. As the exam edged closer, she became louder and more persistent. In some ways, the sports psychologist taught me to hear her better. Delightfully, a few days before the exam I heard her so clearly, it was almost like she was standing next to me. It made it so much easier to identify her and tell her to shut the f*ck up.

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Success took a while to sink in.

I had so carefully prepared myself for the impact of another failure, that I hadn’t planned for success. I scrambled to apply for fellow jobs for the year 2022.

I started helping the next raft of candidates with hot cases and vivas. I felt that paying it forward was the least I could do for all those who had invested in me.

My husband and I celebrated our wedding anniversary; the first one we had in years where one of us was not preparing for an exam.

I had time to reflect on the effect that the exam and the pandemic had had on me. To be frank, it wasn’t great. It has made me even more aware of the importance of self-care and trainee welfare, and how difficult it is to reconcile these with the demands of an intensive care career, an exam, a pandemic.

And of course, the negative voice was still there. She had always been there. She has been a huge driving force that had been pushing me to do better for years. She is a part of me that will occasionally require some gentle restraint.

A few days ago, Melbourne opened its restaurants. In another few days, retail will open, too. I’m awaiting my third vaccination. My husband and I are now planning our future again; finally ready for life to begin.