1. Rebecca
Itap my pencil on the desk as I re-read the question.
A three-year-old is brought to the emergency department with lethargy and vomiting. Their glucose level is 759. Which of the following cell types is affected in this disease process?
My knee starts bouncing, too. I should know this. I do know this. Right? The high glucose level means he has diabetes. So, something in the pancreas.
I read the answer choices once more. All of them are cells in the pancreas.
Shit.
I chew on the inside of my cheek, going through the answers in my head again. I’ve been studying my ass off for this test for weeks, and I have to do well, or I’m screwed. Literally.
I’ve already failed one of my classes this year. They’ll let me make it up over the summer and stay with my class, but if I fail a second one, I’ll have to repeat the entire second year of med school.
Massive tuition costs aside, I can’t fathom what my parents would say.
I read through the choices again as my panic grows. Alpha, beta, delta, epsilon, upsilon. Is upsilon even a word? These seem more like fraternity letters than cell types. I know for sure there are alpha and beta cells in the pancreas and that they’re somehow involved in sugar metabolism, so I cross out the other options.
We’re down to a fifty-fifty chance of getting this right. You can do this, Rebecca.
Because if I don’t, all my dreams of becoming a cardiothoracic surgeon like my dad are shot. My dreams of becoming any kind of doctor are shot.
The student next to me shoots me a dirty glare, probably because my pencil tapping has become a little loud. I tap it against my hand instead for another minute before I fill in the circle for answer A—alpha—and move on to the next question.
I’m sweating when I finally leave the classroom.
My sympathetic nervous system is on high alert—the fight or flight response, with adrenaline secretion and all that. What wasn’t that on the exam?
Hell, I know all about stress and cortisol levels.
Mine are high. All the time.
But it’s how I thrive. I need a high-pressure, fast-paced environment to do my best work. It’s been like that forever, and I figured it would lend itself well to med school.
But the sheer volume of things they expect us to memorize is insane. It’s like being thirsty and trying to take a sip from a fire hydrant. Way more than you ever wanted, and you end up regretting all your choices.
I should feel lighter now that my final exam is done for the year. Most of my classmates are headed to the bar to celebrate the end of the year and the halfway point of med school.
But that’s not in the cards for me, for a few reasons.
First, and most importantly, I’m not actually sure this is the end of my second year. At best, I’ll be repeating pharmacology over the summer.
At worst, I’m restarting the entire year in the fall while my former classmates will be off doing their clinical rotations.
I’ve never really gotten close to any of my classmates, so it’s not like my friends are leaving me behind. I’m more of an introvert, and the competition doesn’t help things at all. I’m better off just keeping to myself and studying. Because if this is the result when I work hard, imagine where I’d be if I went out to the bars every Friday night. But the idea of them all moving on without me makes the thought of failing that much worse.
I slide into my Volkswagen Jetta and pull out of the student parking lot to head home, wondering how to fill my time until the exam results are posted.
They’re usually back fast; the exams get run through a machine that reads our answers and spits out the grades within a matter of hours. I should probably start studying for my summer class, but that seems like it’ll jinx it.
Gym? No, that’s a terrible idea. I don’t even know what one does at the gym.
There’s no way I’ll be able to settle my nerves enough to watch a movie or read a book or anything like that. Plus, those are luxuries, things I do when my life is going well, and I’m not entirely sure it is.
When I finally pull into my assigned parking spot at my apartment complex, I realize I’ve spent the entire ten-minute drive stewing over things instead of actually listening to my podcast like I’d planned. I let myself into the one-bedroom apartment and slip my loafers off, arranging them by the door. I glance at the kitchen, but I’m too stressed to eat.
That’s the beauty of being nervy. It keeps your weight in check, or so I can hope. I had a sweet tooth back when I was growing up, but the further along I’ve gotten in school and the more stressed I’ve gotten, it’s kind of faded.
The extra layer I’m carrying around my stomach and hips, however, hasn’t gone away, and it shows no sign of getting any smaller anytime soon. I grimace at the thought.
I look around the apartment. With the stress of studying for the final, I’ve let things slide a bit when it comes to cleaning. That’s a useful way to spend my time. I nod to myself. Yes. I can get this place back in shape. I always feel better when I’m in a clean space, especially when it smells like the lemon-scented cleaner I use in the kitchen. Perfect.
I tuck my tote into the closet near the door. The vacuum cleaner is in the same spot, so I start there, running it over the living room carpet. There’s something about those nice lines that the vacuum leaves. Even if the carpet wasn’t that dirty to begin with, it’s just so satisfying.
I’m finishing up and wrapping the cord around the vacuum when my phone rings. I swipe to answer without looking to see who it is—and cringe as soon as I hear the voice.
“Rebecca?” Stern. No-nonsense. Loves-you-but-judges-you in the same breath.
“Hi, Dad,” I say, resigning myself to how I already know this conversation will go.
“How was the final?” he says without hesitation.
Like I do every time I’m around my parents, I fall back into my role as Perfect Only Child. “It went well, thanks. How are you doing?”
He ignores my question. “Did you do well?”
“I don’t have my grade back yet.” He doesn’t know about the class I failed earlier in the year. If I have my way, he never will. Because in a family like ours, failure isn’t an option.
“But how do you think you did? Did you know all the answers?” he presses.
How do I even answer that? “I think so. I’m feeling good about it.”
I hate lying to my parents. But even more than that, I hate disappointing them, and if I fail my entire second year of med school, it’ll be beyond disappointment.
My dad is the son of immigrants; his parents moved to America from India when he was little, and he loves to tell the story of how he went from a kid who failed English as a Second Language multiple times between first and fifth grade to a renowned cardiothoracic surgeon.
Not just a surgeon. Cardiothoracic surgeon. He’ll correct anyone who misses that part.
But what he took from his experience is that anyone can succeed with the right motivation and persistence. So how can I tell him I’m struggling with pathophysiology?
I had every opportunity he never had, a fact he likes to remind me of often. I had the private schools, the tutors. The SAT prep courses to boost my score to get me into a top college, which he then paid for.
So, you see why I can’t tell him I’m at risk of repeating a year?
“What does your schedule look like for your clinical rotations?” he asks, apparently satisfied with my responses about the exam for now. “Make sure you have your surgery rotation early in the year, but not too early. You want to have enough experience to impress them, but make it early enough to get letters of recommendation and a foot in the door for electives your fourth year.”
Dad is always thinking five steps ahead while the rest of us struggle to keep up. It’s why he’s such an amazing surgeon. It’s also why I never beat him at chess.
“We don’t have our schedules yet.” True. “But I’ll keep that in mind.” Also true. I just don’t have to mention the part where my clinical rotations might not start for an entire year if I have to repeat second year.
Or ever. Fail a year twice, you’re out. So, I need at least a B on this exam to safeguard my future.
B.
Beta.
Shit. It’s Beta cells that secrete insulin, isn’t it? I got that one wrong.
“…make sure you’re still studying all the time, Rebecca. Finishing pre-clinical classes doesn’t mean you’re off the hook.” Dad is still talking as a sick feeling fills my stomach, threatening to overtake me.
I swallow over the lump in my throat, trying to hide the fact that I’m taking a deep breath. “You’ve got it, Dad. In fact, I’m thinking I’ll start studying now. Get a jump on internal medicine at least.” I feel terrible for lying, but it’s far from the first time.
And if I fail this final—and thus the class—it’s far from the last time, too. But I’m on the verge of throwing up as I think about all the questions I might have gotten wrong.
I place the phone on the counter after I end the call and stand over the sink, resting my weight heavily on my arms.
Breathe in, one, two, three. Breathe out, one, two, three. I repeat the cycle until the nausea has dulled. I don’t think it will disappear completely until I get the exam grades back.
Maybe not even then, depending on the outcome.
I take one more deep breath, then stand up straight and grab the spray cleaner. I pull on a pair of rubber gloves. Cleaning is mindless and methodical, so it can be almost meditative. Spray, scrub, wipe. Repeat until everything is shiny and perfect.
Because no matter how hard I try, my life isn’t perfect. But my kitchen can be.
I move on to the bathroom when the scent of lemon starts to seep into my pores. The porcelain of the toilet is pure sparkling white, but I spray some cleaner in there and start to scrub with the toilet brush.
I’ve honestly never understood why people think bathroom cleaning is so gross. Back when I spent my summers at camp, we had to clean the communal bathrooms once a week. And everyone bitched about it, campers and counselors alike.
But I never minded. It’s a job that has a specific focus. There’s a right way to do it, and if you follow that, you end up with a clean bathroom. Simple.
God, Camp Winnie. I use my forearm to push my hair out of my face as I think about my days at the New Hampshire summer camp. Those were the days, weren’t they? A little bathroom cleaning in exchange for spending weeks in the most amazing place on earth. I even spent a few summers as a counselor while I was in college. Best job ever. Underpaid, maybe, but getting to live there for the entire summer? I would have done it for free.
Okay, maybe not free, now that I think about the time that a camper puked on my bed in the middle of the night. But the other times were amazing. I wish it were possible to be a summer camp counselor forever.
Brett managed, actually. He was a counselor when I was a Ladybugs camper—the youngest girls—and he swiftly rose through the ranks of leadership, coming back every summer. He’s been the camp director for a few summers now. Living the dream.
While I, on the other hand, am decidedly not living in a dream, unless this is somebody’s recurring stress dream. Cleaning a toilet while waiting to hear about my academic fate.
As if on cue, my phone chimes with the alert for a new email.
My stomach flips. This is the moment of truth.
Please, please, please let me pass. I send up a prayer to any god that will listen.
I open the mail app, and there it is. Exam Results - Rebecca Patel.
God, it’s so cold and impersonal. Couldn’t they add a smiley face or frown or something to give you a hint? Like, *smile emoji* Here they are! The results you’ve been waiting for! Or *frown emoji* Sit down, love. You’re going to need a stiff drink before you open this one.
But no. Just Exam Results.
I sit down, just in case, chewing anxiously on my lip as I click on the email to open it.