Clap Three Times

Jul 29

“Will you be claiming any CME credit for this conference?”

“No, I’m just here for the show” I answered the conference greeter sarcastically.

I do that when I am uncomfortable. She was confused but smiled warmly as she pulled the manilla envelope with my name written in Sharpie on one corner.

“Right here!”

“Your name tag is inside along with a few more informational items about the conference as well as opportunities to take advantage of while you’re here in Philadelphia. There is coffee and a light breakfast over here to your right and the breakout sessions will be beginning shortly in Ballrooms A-G.”

“Great. Thank you.”

After grabbing a black coffee, I circled outside the conferences rooms reading the descriptions of each session posted on a monitor just outside the door. After reading them all, I chose Ballroom B where a session on integrated medical curriculum was about to begin. But first I lingered in the hall for a bit, not wanting to leave too much time for small talk so early in the morning.

I looked down at my watch. The clear glass face covered the mechanical time piece along with three smaller timepieces that I never really figured out the use for; I think one was a stopwatch. I dropped the watch in my kitchen a while back and the largest mechanism that made the watch a watch had been stuttering on the same hour and minute for some time. Still, it looked sharp even if it could not tell time. You know what they say about broken watches.

Ballroom B was a large room with circular tables set for 6 participants each spread across the stiff hotel carpet. Towards the back left corner of the room was a podium next to a projector screen showing the title page on a PowerPoint presentation. Our facilitator had not yet arrived, but it was obvious which direction all of the attention in the room would be directed. As such, the tables furthest away from the podium filled up first. There sat large contingents of participants who either came to this conference together or have some history on the conference circuit. It was 7:30AM, but it felt like happy hour back there.

Closer to the podium the attendant crowd grew sparse. The filled seats were occupied with people playing on their laptops or pretending to be busy with a phone call (again, it was 7:30AM) to fill the awkward time before the session starts.

I found a table with four open seats and although the table was right next to the screen, I told myself it should be a good view of the presentation. Before I arrived, two gentlemen had established themselves and were chatting as I walked up.

“Morning.” one of them greeted me curtly.

“Is anyone sitting here?” I asked.

“I guess you’re about to” he said before returning to his newspaper.

Like most of the people on that side of the room, my new neighbors were both in their 50s or 60s, and attending physicians at major academic medical centers in the United States. One had Anesthesiology on his nametag and the other wore Allergy and Immunology. My nametag simply said Medical Education.

Eventually the other gentleman who remained quiet upon my arrival introduced himself. We got to chatting and he explainined to me where he was from, how long he had been coming to these meetings, and what I could look forward to as a first time attendee. The other man who had greeted me remained silent.

We hit a pause as it came my turn to make an introduction. I cleared my throat, told them my name, where I went to medical school, the institution I worked for, and then I paused again. I felt a knot in my throat knowing what was coming.

“And I just teach” I said gingerly.

I knew this dance all too well by now. The inveitbale question was about to be asked, if I just waitied for a bit. Finally, one of them asked.

“Oh, you don’t practice? Did you do a residency?”

He asked the question as if on cue, and this is where my monologue typically began whenever I told my story to new acquaintances. I took another deep breath before telling them that I had started residency, twice in fact. I matched into Internal Medicine at the end med school after stumbling through my clinical years without feeling like I ever found my niche. When it came down to it, I matched into what I knew best without knowing what was best for me.

The following year I entered the Match again, this time in Family Medicine. I spent the prior year convincing myself that I just needed a fresh start in a smaller, community program to spark my fire as a professional and a person. Virtually none of the time went into self-reflection or addressing the depression and anxiety that haunted me through med school. And absolutely none of the time went into putting the pieces back together after my long-term partner decided she had enough and moved out.

By the time I got to work in my second residency program, I was a shell of the person that went through medical training, and only the ghosts of my old social support systems were left after my classmates and friends moved on to their new jobs and adult lives. Within 18 months of graduating medical school, I quit two residency programs.

After leaving my Family Medicine residency, moving home with my parents was a necessity both emotionally and financially. I applied to every odd job that I could find, eventually finding a job as a personal trainer at a corporate gym. Shortly after that, I was also able to find work teaching nights in biology and health sciences as an adjunct professor. While I was hardly using my medical degree to its fullest, I found respite in an environment where it was my job to share. Most importantly, my job was to share what made me passionate about medicine in the first place: science.

After my first semester teaching, I was offered the chance to come back after the winter break to teach three sciences classes; two during the day and another night class. I leapt at the opportunity and made the most of the chance to develop my craft of taking my understanding of the sciences and framing in a way that my students can understand, just like they trained us to with patients.

At the end of my first year as a college instructor, I was offered a full time position as an assistant professor of biology at the small liberal arts college that gave me my first opportunity. Within two years, I accepted another position as assistant professor; this time at Creighton University in the Department of Medical Education.

At Creighton, I was one of the instructors in clinical anatomy for medical students and was given the opportunity to take ownership of the muscle physiology curriculum. Among my other duties were promoting integrated learning via the flipped classroom approach as well as exam item writing, which is how I came to be sitting at the front of in Conference Room B that morning with my two new friends.

They stared back at me narrowly; I was used to it by now. No longer did I get anxious or feel attacked when someone I just met focused in on that one detail of my life. I knew that going into medicine would define me, and I knew choosing to quit would as well. I learned this for a fact when I told my program directors I was leaving. I learned it again when I was applying for entry level jobs just to pay the bills, despite a medical degree, and again when I began teaching students that were in many cases older than me. And anytime casual conversation made it to the So what do you? phase. I knew how to frame the story in a way that was at least palatable to me, and I did just that.

What I had not told them was the question on my mind for months since I began teaching medical students full-time: If I am so passionate about medicine, how can there not be a place for me in medicine?

Having not found a quick and clean answer, I knew why the two gentlemen looked at me the way they did. But the question had been gaining momentum in my mind and I felt compelled to share my struggle. I wanted to tell them that the one consistent theme on my journey was that I excel when I can share the things about which I am most passionate; that if I had not made the changes that I made, I never would have learned what fills my cup as a person; that the number one reason that I am able to relate to medical students was not my age but the fact that I remember what it’s like to have to define yourself before you know yourself.

I wanted to tell them that I had been researching specialties and residency programs, and that I felt that Pathology would be the perfect way for the person I have become to bridge my teaching interests and newly developed skills with clinical medicine. Before I could think it through, I was opening my mouth to tell them what had been on my mind.

CLAP!

A disorienting slap rang from the back of the room. I was not sure where to place its source, but looked back to see a sharply dressed woman weaving through the tables saying good morning to the attendees. I guessed she was our facilitator and that she was slowly gathering the room’s attention through the tried and true Clap If You Can Hear My Voice technique.

The tactic begins with the facilitator softly saying “Clap once if you can hear my voice”. Anyone who can hear her voice should then clap once. Then a few seconds later, “Clap twice if you can hear my voice”. This uses the audience to generate enough noise to disrupt and ultimately end any side conversations in order for the facilitator to gain the attention of the room without directly telling everyone to shut up.

I had seen this done before at conferences. It seems like a kindergarten tactic but I’ve found it works best on adults over 40 years old. I would normally shut up and listen but I had begun down a path of justifying my presence. I was not ready to spend a whole session as the mixed-race amateur at the front of the room with the good old boys. I started to sweat, but I still had their attention. I tried again to speak.

“Clap twice if you can hear my voice” our facilitator whispered as she wandered further between tables.

CLAP! CLAP!

For the record, clapping your way to order is tyranny by percussion, and I now stand firmly against the practice. Most of the room was with our facilitator now; suffice to say you find out who your friends are with the second clap. Our rightful leader had the podium, and I had lost the battle for Ballroom B.

The session began, and what went unspoken at our table was soon forgotten. We locked-in on the session topic: Challenges of Integrating Curriculum. When prompted by our facilitator we broke into discussions about the importance of context without sacrificing detail, the style and substance of sharing ideas, and the need for empathy in our instruction as well as our graduates.

“If we can’t see what they see, they’ll never believe that you know what you’re talking about” I said emphatically at one point, accidentally spilling a bit of my coffee with a flailing hand.

“I can see why you chose teaching!” one of them said with a smile as I wiped up my mess.

The dynamic we had begun with was gone, we had become peers. I felt satisfied that I had convinced them (and thus myself, once again) that I had a right to be there. Soon our 90 minutes were up, we shook hands and parted ways. After wandering through a few more speakers and workshops, the conference day was done and I went back to my hotel.

Once in my room, I pulled my phone from my pocket; the lock screen showed the date: Friday, March 16th 2018. But as soon as I opened up social media, I was reminded of a greater significance to the calendar; it was Match Day. It had been five years since my first Match. Most of the folks graduating medical school that year were strangers to me, but between the hashtags, algorithms, the and sheer volume of people involved in the celebration that is Match Day, it was impossible to ignore.

My thumb ached as I scrolled through the posts and pictures of the glowing grads-to-be. The image of their enthusiasm inspires me to this day. Sails filled with blind benevolence, they were ready to embark on their professional medical journey. Finally the broad brush of pre-medical and medical training would begin to narrow-in on the future they had been dreaming of for so long. They were rising, and I cannot deny that I envied them.

I knew better to believe they were rising without resistance, though. I remember the anxiety and imposter syndrome of graduating medical school, yet they were going forward anyway. Going towards what made me turn away and leave my training a few years earlier. I fell asleep that night wondering, seeking, harder than ever before for the answer to the question: Where do I belong?

The next day I was surprised to wake with a sense of peace that avoided me the night before. Almost as if I’d spent the night making a to-do list. I couldn’t put my finger on it, but I felt ready. I felt able.

At the same time, a stirring feeling would not allow me to loaf around in a fancy hotel bed under a comforter that was classier than anything I owned. It was not so much anxiety, but a need to move. Something inside me knew it was time to get to work. The only thing I had to do that day was go to the airport and fly home. My flight was not for four more hours, but I felt restless. I needed to get moving. I decided to get myself together and head to the airport early.

I was done packing my bags and ready to head to checkout when I decided to pull my Macbook out and opened the internet browser. I typed “When is Match Day?” into the search bar, then grabbed the note pad that came with the hotel room. Just beneath the stationary header I jotted down the date on the screen.

“03/15/2019”

There was no single moment that I can remember deciding that Pathology was the right path for me, but I know the momentum I woke up with that day has carried me every day since. As I sat in that hotel room, I did not know how I would get back in the Match, get letters of recommendation from physicians willing to vouch for me, or find the words to express the reasons for, and the meaning found by embarking on my own long bizarre journey. But that morning I did know that I would figure it out.

Just like I found the strength to walk away from a future that I did not believe in; just like I found resilience in learning how to define myself on my own terms and in my own vision; and just like I found my voice only after losing my way; I was going to figure it out.

I zipped up my bag with my Macbook securely inside. As I stood up, my eyes crossed a clock on the wall just in time to see all three hands turning over the top of a new hour. It was time to go home.