Chapter 7
PAY-TO-PLAY
Or is the true cost of medicine the destruction of self-worth that comes from rising as the best and brightest of your hometown, to falling to the worst and worthless among the elite?
THANATOS
The next few weeks reduce our relationship to incredibly fleeting and virtual moments while Kane’s on nights, barred from seeing the light of day.
I offer to meet up with him early dawn or dusk, but he insists he’ll spare me from further sleep deprivation, planning more dates when he’s back on days and “vaguely more human.”
I’m frustrated, but also a little relieved, that I can attempt to humanize him without facing his scathing sarcasm directly.
Especially after the car—which is the nicest thing I’ve ever owned—I’m reminded it’s only right to uphold my end of the bargain every time the four-wheel drive delivers me safely to work.
And every time I use his stolen I.D.
I text him assignments to make him ‘likable’ in between working on the final touches of my residency application.
Percy
Okay, here’s your homework
Kane
Does it involve the retrieval of my food card
No
I’m scared of Jade’s tirade of wrath
...
Fair
Anyway
Learn the names of all the residents you work with daily
Not just your co-residents that you’re trying to impress (the surgeons)
I heard you made one cry once
There’s not a moment’s hesitation before his next text.
Kane
That was an attending, actually
And he deserved it
I light up. So it’s true! An attending? How?
Percy
I don’t care. Be personable.
And smile. If you look like you hate people, they’ll hate you back.
Kane
What if I DO hate people? They’re loathsome
Pretend you’re friendly and love everyone. That’s what I do.
Weird
Do you want to get anything out of this arrangement?
This is easy mode
I could have challenged you to radiate positivity 24/7
I will attempt one singular smile daily
Well, at least he’s trying…
While I’m playing on my phone, my other two recommendation letters arrive, and I eagerly add them to my application, manifesting good vibes ahead.
A day later, I’m draped over my bed after work, texting him encouragement before his shift begins at our usual twilight correspondence.
Percy
Homework for today
Find out if anyone you know has kids and ask about them
Everybody loves talking about their kids
His reply trickles in an hour later.
Kane
Persephone
Dearest
I am a grown man
I’m going to look like a predator if I randomly start asking women about their kids
I can almost hear the acerbity dripping from the screen.
Percy
Only if you do it like a creep
Be normal
Kane
…
Are you familiar with my reputation here
He can’t hear my sigh, but Hyacinth’s cats can, and they meow at my door. I pause to let them overtake me, still texting him as their little paws make tracks on my skin.
Percy
Okay, then I’m going to challenge you instead. Invite a co-resident out for drinks before your next day off
Kane
I get one of those over a 28-day period
Then ask on day 28
I take a break to focus on proofreading my CV. Still, I am delighted weeks later by his sudden interruption: a picture of him and another churlish-looking resident grimacing over two beers.
Percy
Proud of you! A whole friend
Kane
He only came because I said it was on me
I don’t have friends
You have me
The little bubble pops up, disappears, then pops up again for him to respond with the oh-so-eloquent:
Kane
The roads of Rusty grow bronze as the leaves fall and stack over themselves. A few bright, crimson flurries brush against the window by my desk while I procrastinate researching residency programs, sending Kane ‘assignments,’ instead.
send a medical student home early
‘Their whereabouts are a mystery to me,’ he claims, ‘they can send themselves home when they’re bored.’
hang out with your friend again
He vehemently denies they are friends, despite sharing another drink weeks later.
ask your co-residents about their hobbies
ask your attendings (after they’ve mentioned it, to avoid the ‘creep factor’) about their children
ask about pets (because who doesn’t love their pets?)
He does these last ones without (audible to me) complaints, and with much satisfaction, I think his reputation is improving. I haven’t heard rumors of “Dr. Demon” in weeks.
And despite being stuck in the same hospital as David, he averts his eyes every time he sees me, eluding me like I’m a black cloud. I can finally relax when I go in, not flinch every time golden hair flashes by.
When editing the same application over and over again makes my head ache, my thoughts stray to Kane and how his reapplication cycle is going. I should ask him about it. That’s what a good friend would do, right?
Percy
Do you want to practice interviewing together? I have some OB/GYN mentors I practice with, and they offered to practice with any of my other future surgeon friends
He takes hours to respond, which is out of character for him.
Kane
No
And then, nothing for days.
I keep researching programs, reluctantly crossing out any that won’t interview students from my state (guess we really do put the MID in Midwest), and debating how best to allocate signals.
‘Signals’ when you apply to residency are like “You’re my top choice!” flags, 3 gold for your top 3 programs, and 15 silver ones for second choice programs.
It’s hard to know what to assign where. Should I take my chances and set all 3 gold for Ivory Towers? Should I bother with keeping them silver and send gold signals to my ‘home hospitals’ that I’ve already rotated at and who I (presumably) think like me?
A dull ache throbs behind my eyes while I fret. Trying to play strategy games makes my brain feel like it’s shaking, a muscle strained under tension for too long.
Jittery and off-balance.
Percy
How many of your signals did you assign to top programs?
Kane
Ask someone applying to OB/GYN
But after a few minutes of my anxiety spiking while perusing internet advice, he responds again:
Kane
My dumbass only signaled top programs
Don’t do that
We all saw how that ended
You’re MD not DO so you should be fine
But be strategic
After a few minutes, he sends another text: a MoonMoonies gift card.
Kane
Consolation for enduring this bullshit
Go get coffee and apply smart
Throat tight, I decide to play it safe and avoid signaling any top programs.
I can’t keep making the same mistakes.
If I’d played it safer in undergrad and studied harder for the MCAT, this never would have happened.
If I’d swallowed the $80 application fee per out-of-state school, I wouldn’t be trapped in Rusty.
If I’d just been better, smarter, wiser, I wouldn’t be stranded here, second-guessing every decision, overriding years off my self-confidence every time I strike a program off my list.
Much like the naked, skeleton-esque trees greeting me on my drive in, I am also working myself to the bone, giving 110% at rotations only to tumble into my desk at home and keep panicking.
I’ve been poring over the last 10 years of match data from my medical school, trying to see who matched what, where, and when.
If they’ve never bothered to interview someone from my state, there’s no way I stand a chance.
Unfortunately, the list of such programs is longer than my list of viable options.
I need a distraction.
Percy
Do you want me to send you food? You must be exhausted on nights, it’s been nearly a month and a half
This time, his response is nearly instantaneous.
Kane
I’m not broke
I resist the aggravating urge to shout at the screen. That’s not even remotely what I said.
Percy
It’s thoughtful. This is how nice people act
Kane
Financially irresponsible people. Feed yourself
Ugh. I groan and toss my phone onto the mattress.
Now he has an attitude?
I hastily switch my notifications off, deciding I need to sleep instead of argue.
I can’t do this anymore. My pulse is racing, my breath comes out in gasps, and my head throbs from racing through every possibility, every flaw in my personal match algorithm.
Do I apply to 20 programs? 30? 50?
Last year, someone applied to 200 OB/GYN programs and still didn’t match!
Two! Hundred!
If they couldn't do it, what chance do I have?
What if I apply too broadly and burn money I don't have?
What if I apply too narrowly and don't match at all?
What if I've spent the better part of a decade chasing this one thing only to end up exactly where I started—except older, deeper in debt, and with a spectacular new failure attached to my name?
My stomach twists.
I can practically hear the questions already.
What happened? You didn't match? After all that?
But I thought you were so smart…
After nearly an hour of pacing, plotting, and packing my luggage for my upcoming aways, I finally reach out to him again, determined to do something that’s not unravel at the seams.
Maybe he’ll bite now that he’s had time to recover from me insinuating he’s below the poverty line.
Percy
Have you been continuing to make friends instead of enemies?
He responds more quickly this time.
Kane
I asked about their hobbies, as you ordered
Specifically, I asked if they had any weekend plans after nights
They said, “I’m going to sleep, dumbass.”
I can almost hear his hoarse judgment through the phone, and grin.
Percy
But at least you tired!! Look at you, socializing.
Kane
Tried
*I* am tired
I hope you didn’t submit your residency application with this grammar
My fingers dig into my plastic phone case. Warm, then cold, then downright mocking. Why do I even bother? I fling more clothes into my shoddy luggage, looking wistfully at my phone, wondering whether I should bother telling him the day I leave the state for my last out-of-state sub-Is.
Booking my ticket, I throw my phone back into its charger, accepting defeat.
What if, what if, what if!
Tossing toiletries and last-minute clothes into my suitcase, I’m packing for my plane trip the morning of, so exhausted from my 14-hour shift yesterday that I fell asleep as soon as I got home.
What if I only signal low-tier programs, but I’m a better applicant than I thought, and they don’t interview me because I’m too good a candidate?
What if I only signal mid-tier programs, but I blow my chance at top-tier programs, and can’t get a fellowship after graduation?
What if I only signal top-tier programs, and don’t get any interviews at all because I aimed too high?
I’m racing out to my taxi, thoughts racing with me, making it just in time to stare at my phone while the driver ricochets away.
I have time. I made it.
I should tell my fake boyfriend, if only so he’s not worried when I message less.
Percy
I’m going to go on some away rotations soon, like right now, heading to the airport. Do you still want to text nightly?
Kane
No
…
My stomach sinks, wondering if trying to force-feed him into personality pushed him away too quickly. That’s what David said, anyway. I’m too clingy. Nobody wants a girlfriend who checks in on them daily. Affection for him was always suffocating and ‘grotesquely involved.’
Maybe I should take it as a sign that he won’t keep texting.
That I’m disappointed by a man I hardly know, glancing hopefully at my phone for another message, instead of paying attention to the airport drop-off.
His scant replies must be a signal for something.
I shuffle into the terminal, the cacophony of noise blaring in my ears.
Families rush through security in hordes, fathers directing their kids to Watch your step! and Stay out of the way, Timmy! while my man can barely respond in a timely fashion.
I yank my whistling luggage through the concourse, frustrated.
Delusionally, I do think we connect well in person; I just can’t reach him on the phone.
I line up at the gate, doubts rushing in my head, surrounded by the hum of agitated passengers and staticky boarding number announcements.
When I finally cross the tarmac, glacial air whooshes past me, and I have to cross my arms to preserve heat.
Life is about freedom, right?
Nobody is freer than a woman without the shackles of a relationship to ground her, entering the stagnant plane air.
I’ve sacrificed so much for this career, for my future, as my present self cramps into my narrow, affordable middle seat.
Months of solitary preparation for the MCAT while COVID ripped the world apart.
Hundreds of dollars and hours spent on applications, interviews, and equipment.
Thousands of dollars and thousands of questions from the Universe, AmSmart, and Shady question banks to pass my board exams. The golden decade, my 20s, robbed for the pursuit of higher education and saving lives.
And the whopping $250,000 as the base cost of my education, divided over 4 years of student loans and 4 lost years of my life.
All combined, close to $300,000, and I’m here worried about some boy?
This whole experience has been a game rigged against me, and I’m tired of losing.
I’ve been clawing my way toward any shred of relevancy, sacrificing my sleep, dismantling my self-worth to impress people who will never see me again, playing games with my physical and mental health to outwit a fucking algorithm that’s supposed to know where I belong better than I do.
I’ve missed my college friends’ weddings to impress on sub-is, unintentionally insulting them so badly I doubt they’ll ever forgive me.
I’ve lost contact with all my hobbies, overriding the time I used to spend on them with Anki cards and esoteric, board-relevant knowledge.
My former friend group from medical school has slowly stopped contacting me, taking it as a personal slight when I dumped the guy they thought was so perfect for me.
And for all I know, I may never find love again. Kane is impossible. Dating app men ghost me as soon as they find out I’m more educated than they are. I don’t have any hobbies left to meet people in. And I’m going into a field that’s almost all women!
Heart hammering, at the last minute, I connect to the Wi-Fi on the plane and sacrifice one of my gold signals away from community to Ivory Tower.
I exhale sharply, breathing hard.
If my whole life is going to be pay-to-play, I should be playing to win.