I become a good liar. It is the same routine. I sit with my friends through chaotic clicker sessions. I listen to their explanations and nod my head. I pretend to understand. I attempt taking diligent notes. I laugh at the carefree jokes exchanged between questions. After class, I return to my room. I lock the door, change into pajamas and curl onto the carpet. I sob. Long, defeated, and lost sobs. My body shakes with the silent cries. Some days they are cathartic. Most days I am hollow. I wipe my wet face of any evidence. I study. Someone knocks on the door. I put on a smile. A pseudo-convincing smile. It is enough to convince them I am okay. No one knows.

I began first year with arrogance. I was so proud of myself. I got exactly what I wanted. I wanted a medical school close to home directly after undergraduate. My wish was granted. I was satisfied and simultaneously smug. I came from a competitive school. I was a good student. I wanted medicine so badly. I was chosen out of so many. And I would thrive, I told myself.

Several weeks pass. I look strained but confident. It’s a lot of work, I tell everyone outside of school. But I have such a cool story for you. I wore my white coat and interviewed an actor patient. I dissected the fine arteries along my cadaver’s arm. I made a new friend from class.

I study. But I am so naïve. I walk into my first exam. Everyone around me looks terrified. They say ignorance is bliss. Perhaps that is why I am strangely calm. I begin the exam. My stomach lurches. I do not recognize these details. And a panic grips me. I second guess through questions I know. I pick convoluted answers for the rest. I leave, my heart pounding.

This marks the beginning. My self-worth slides slowly downhill. I don’t know how to study. I struggle to keep up. In class, my eyes dart towards the door. Any day I will be forced to leave, I imagine. Touro will realize I was a mistake. Some deserving person was denied their seat because I stole it. I watch the way my classmates walk. How they stand proud and tall. They brag of grades and study schedules and triumphs I thought I would share. But when I look in the mirror, I see incompetence and failure. I look away.

I walk into professors’ offices for help. I see well-meaning pity in their eyes. I shrink back. Is everything okay at home? Has someone died? They ask. I am ashamed. I have no such life emergencies. How do I tell them that no, only a piece of me has died. My spirit once had color. I don’t know who I am anymore. I lose hope. Thus, I lose myself.

And then the tides change. Twice.

The U.S. elections come in November. I respect democracy. I celebrate the diversity of different opinions, beliefs and backgrounds. Differences bring complexity and richness to our world. But that night I don’t sleep. I know the repercussions. I am brown, Muslim and female. I am familiar with a world that paints judgements and labels. But I am unfamiliar with this new reality. A reality of being acceptably despised. A reality that threatens me, my family and countless others like us. That night I think I will crack open.

I don’t.

I realize I am sick of being my worst enemy. I hurt. But I see tonight that others hurt too. At least we can hurt together. I am still needed.

And I make a promise. I will stay strong. Staying strong means letting others in. It means having the courage to productively approach struggles. It means seeing difficulty as opportunity. It means appreciating warmth and light again. It means smiling. In such uncertain times, a smile can change so much.

Winter ends and spring begins. I enter spring semester with delicate hope. I trust more of my classmates. I appreciate the quiet and consistent kindness of people around me. I put all my energy into coursework. I still fall down. But I have more resolve to get up again. I begin to believe I am not alone.

Suddenly it’s May. Finals weigh heavy on tired spirits. The stress is palpable. So I ignore the gnawing pain in my lower abdomen. I blame it on anxiety. I study and pray I finish first year with myself intact. I daydream about my summer.

My stomach aches all week. I give a presentation for class and go home. The next morning, I can’t leave bed. My parents urge me to get help. I want to refuse. I don’t have time for the hospital, I argue while wincing. I can’t leave my dream now. The pain worsens and I stop fighting. Two ERs, an ambulance ride and much morphine later, I am told I need immediate surgery. I have an endometrioma the size of a grapefruit. It ruptured over the week and I am bleeding inside. I want to scream. Not now. Give me your strongest pain meds and let me return to my dream. I am so close. I cannot repeat first year again.

The pain leaves me no choice. I consent to surgery and swallow my fear of being cut open. I hate being a patient. I loathe being so helpless. We all expect a small procedure with a two-week recovery. The surgery is more invasive. I leave the OR with a big incision and the promise of a six-week recovery. I fear the worst. I fear my limited time. I have so many exams to make up. When will I feel well enough to study? Forget about having a summer. Will I finish in time to rejoin my class? I fear the medical leave of absence. I know of so many who do not return.

My classmates battle finals. I take constant pain medications and sleep. I think of walking. I imagine showering and laughing and feeling like a person again. They are alien realities. You never realize how much you have until it’s taken away.

Yet life as a patient is so valuable. It reinforces the why. It reminds me of why we study and hope and pray so desperately to get through these first two years. I watch my health care team with new admiration. It is a privilege watching genuine healers. They tirelessly care for others at their most desperate moments. They are good at their work and have tremendous humanity. I am inspired. I am reminded of my why.

Slowly, I walk. The medication doses decrease. I am more self-sufficient again. I smile and cry over the tremendous love I receive from so many. I realize then, do not underestimate how loved you are. Do not forget to show your people how much you love them back. Without them, you are nothing. Remembering such love and support, I begin my exams. I study through the warm summer days. Nothing is the end of the world, I repeat to myself when I get desperate and tired. I have come so far despite the falls. Dreams are worth fighting for.

Pause.

This story is difficult to share. I am a private person. I do not easily share such personal accounts. I dread being judged for being too vulnerable. Vulnerability is frowned upon in a medical culture that champions invincibility. We hold superhuman expectations for human physicians. For many, vulnerability implies weakness. It is for the melodramatic and immature. Some believe that a good doctor cannot be “weak”. To imply I am struggling implies I am weak. Weakness means I am unfit to be here.

I disagree.

There is an old Bengali saying. You cannot have pure gold without blazing flames. Fire must smolder and scorch the metal innumerous times. It hurts to make gold. We all walk through the flames of our struggles. Some flames are longer and more difficult than others. We cross the flames eventually. We emerge older, wiser and stronger on the other side.

To pretend there are no flames is to belittle struggle. To belittle struggle is to belittle the human experience. Being human comprises of suffering and growing from our flames. The day we escape struggle is the day we are dead. Are physicians not human too?

This story accounts my year of walking through flames. I know the nature of our confusing, unfair world. Struggles are unending. But I hope we think twice before making judgments. We all have stories. We have no right to judge another’s story based on the chapter we walk in on. I hope we keep showing each other the compassion we will show our patients.

Un-pause.

I finish at last. I finish a week before second year begins. I rest. I relish I am still here. I am a dream-chaser determined to fly. I am humbled and grateful.

Farah Aziz, OMS-II