“The Love Song of J. Alfred Prufrock” is one of T.S. Eliot’s most celebrated poems. First published in 1915, it describes Prufrock’s intense angst as he contemplates professing his love to a woman. With each verse, Prufrock finds more reasons not to act on his desire: because he is old, because he will be misunderstood, because he does not appear presentable.
I was reminded of “The Love Song” when meeting with a junior colleague from Internal Medicine about to embark on the Match. His anxiety about the road ahead reminded me of my own Match experience (now more than a year ago) and of the constant uneasiness it inspired.
In Canada, Internal Medicine residents in their second and third years embark on a series of clinical electives in their specialty of interest. The objective is to match to a fellowship program and thus become the physician one always hoped to become. The match process is stressful, even for the most even-keeled. Clinical electives essentially amount to sustained job interviews in which the resident’s merits are scrutinized and (seemingly) endlessly evaluated. A favourable impression can open doors to exciting career opportunities while a bad impression can be ruinous.
T.S. Eliot certainly didn’t write “The Love Song” for residents hoping for a fellowship match but even so, I found elements of Prufrock’s struggle to be so relatable that they could have been written just for me. For example, as I moved from hospital to hospital, adapting to different clinical supervisors and support staff, I inevitably had to “prepare a face to meet the faces that you meet” (p.131). Expectations varied so differently between people and places that I was constantly recasting myself to fit the expected mould. For example, where did people mark the line between keenness and overeagerness? How much did people expect me to do on my own, before asking for help? And even, which jokes were OK to laugh at? These expectations could be at once as minuscule and as game changing as, for example, whether the attending preferred to be addressed by his or her first name or with the prefix “Doctor.” There were no rules and common sense could often lead you astray.
I arrived at each new rotation motivated to learn and eager to create a good impression. I was “Deferential, glad to be of use / Politic, cautious, and meticulous” (p. 135). This led to obsession with the smallest details. Like Prufrock, I wondered, “Shall I part my hair behind?” (p.135), which resulted in taking two glances in the mirror instead of one. During clinical rounds, I debated reaching into my bag and grabbing a snack: “Do I dare to eat a peach?” (p. 135). Once, assigned to care for a particularly complicated patient, I presented what I hoped was a comprehensive management plan. The attending listened without saying anything and I wondered, did he think I was “At times…almost ridiculous / Almost, at times, the Fool” (p. 135)? During a group “pimping” session, the attending asked a difficult question to which I thought I had the answer but I wasn’t sure and, like Prufrock, I asked myself, “Do I dare?” (p. 131).
With the number of applicants often far exceeding the number of available positions, my vulnerabilities – like Prufrock’s – were readily exposed. I was pitted against others and felt the weight of those comparisons – as well as their implications – acutely. When others spoke knowledgeably on a topic I knew little about, I couldn’t help but feel like an outsider, an intellectually outcast Prufrock: “In the room the women come and go / Talking of Michelangelo” (p. 131). Everyone seemed to know something I did not and when I chimed in to the discussion, it was as if “a magic lantern threw the nerves in patterns on a screen:” (p. 134).
Clinical electives were only a part of the match process – the other equally important part was selling myself on paper. The phrases “personal statement,” “curriculum vitae” and “extra-curricular activities” acquired a special and unnerving significance. The task of representing everything worthwhile I had done in a few documents was overwhelming, to say the least. Who decided what was worthwhile? How could I avoid overplaying a less important achievement (an annoying habit which produced a meaningless CV) while humbly yet justly describing a more valuable one? I was eager to get it right and devoted countless hours to grooming these word-pictures of myself – like Photoshopping a good image into an outstanding one, which hid my “bald spots” (p. 131) and “hair … growing thin” (p. 131).
The fact that I held editing power over my paper self was at once a boon and a curse. In the hospital, I performed in real-time – unable to erase a misstep or take back a fall. What was done was done. On paper, however, I could revise to no end. This inevitably produced “Time yet for a hundred indecisions, / And for a hundred visions and revisions” (p. 131). I saw the same personal statement go through more than a dozen drafts, each seeking to marginally correct the deficiencies of the former. And yet, was I truly making improvements or was each round of edits simply making me sound more artificial as I traded the dynamism of a first or second draft for the properness of a 20th? “There will be time to murder and create” (p. 131), writes Eliot. Looking back, I must have murdered and created myself anew a hundred times.
This was not the first match in which I had participated, and yet, contrary to the advice of well-meaning friends, I could not simply use the memory of prior successful matches to build confidence for this one. Our old accomplishments have a tendency to recede into a dusty and irrelevant past. With each new career checkpoint, we become part of a progressively smaller and more refined pool of applicants who have done all of the same impressive things we have – and more. Was it truly worth reminding myself that I had gotten into medical school, and then into residency, when all of my closest friends had done the same? If anything, the thought inspired more anxiety than confidence. I was up against the kind of people who wrote papers on their post-call days and presented at conferences during their vacations. Among them, who was I but a “pair of ragged claws / Scuttling along the floors of silent seas” (p. 133)?
There were times when this pressure proved too much to bear. Like Prufrock, who is tormented by the possibility of rejection, I too occasionally found excuses to abandon what I truly desired, simply to save myself from embarrassment if my efforts met with failure. In my more vulnerable moments, these excuses transformed from hypothetical musings into legitimate alternate possibilities that promised to free me from uncertainty. But by the grace of a few close friends and a very supportive partner, I clung to my chosen road. Now, one year later, having found a match to my desired specialty, that heartache seems a small price to pay for the chance to do what I love every day.
To my junior colleagues about to embark on the Match, who may be wondering with a sense of trepidation, “Do I dare?” (p. 131), I hope my experience gives you the assurance to answer with a courageous Yes.
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I’m sure the experience is different for people who didn’t match to their speciality or location without any reason/explanation as to why they didn’t. This piece misses on that.