The morning of my Board exams, my mother packed me a lunch comprising of seedless grapes, two Greek yogurts, a cheese sandwich, a bag of pistachio nuts, two cappuccinos, a diet coke, chocolate-covered coffee beans and a pouch of pretzels.
“Mum, this isn’t the Hunger Games,” I joked.
“Well no duh. You have absolutely zero hand-eye coordination,” she said.
I gave her a sour look.
“But if there was ever a nerd equivalent, this would be it,” I said, compensating. Someone needed to deliver a pep talk, after all, and clearly mum wasn’t stepping up. “Today, I do battle.”
Mum ignored my inquiries about whether we had any war paint lying around the house. But this was hardly overkill. The USMLE Step 1 exam, otherwise known as the Boards, is an eight-hour test, designed to test medical students of the completeness and depth of their preclinical learning. Commonly taken right at the end of the second year of medical school, before students transition from classrooms onto the hospital wards, the exams represent a months-long effort on our part to frantically cram mountains of information, from the basics of mitosis to the specifics of anti-diarrheals, in hopefully a systematic and organized way. The three-digit score that one receives four weeks later plays a part in determining a student’s competitiveness for certain residencies and such. To what extent – no one can really say. And therefore no one wants to chance it.
Did I mention that it’s an eight-hour test?
Much this year has been about such numbers. The number of hours you can study a day. The number of practice questions. Percentages. Percentiles. Five-hour energy drinks. The number of times you looked over the glycolysis pathway and still forgot an enzyme. The number of simulated tests. The number of days you overslept and missed classes out of sheer exhaustion.
In late September, I met with an academic advisor at school for help in planning a study schedule. She pulled out a college-ruled notebook and drew a long horizontal line intersected with many little strokes. In neat print, she outlined the various books and web resources I might find helpful and the goals I needed to be reaching by various dates on the timeline. She had relationships with many a successful student in the past, she said. I nodded fervently. Surrounded on all sides by what I could do, I just wanted someone to tell me what I should.
“I would advise you that as you move closer to test, to limit how much time you spend on other activities,” she said.
I assured her that I’d already given up responsibility for various clubs at school to incoming first years, and that my summer research was wrapping up as well. She nodded approvingly and added that she also meant time that was spent on friends, dinners and television.
“Try and limit yourself to less than five hours on those,” she said.
That sounded reasonable.
“Per week,” she said.
My jaw fell open.
This year’s meant different things to different people. For my friend K, it’s been a time to really consolidate information and commit things to memory “in a very serious way.”
“If it weren’t for the Boards, I would have never bothered to remember tumor markers or renal equations,” she said. “I would have been content with looking that stuff up on my iPad apps – stuck at the fundamentals forever.”
L told me about his insomnia. Where in college he used to balance his coursework, lab, frat, student council, and girlfriend with enviable ease, now L had done trials of melatonin and already moved onto prescription sleep medicine. He estimated that at least a third of his med school classmates were on some kind of depression, anxiety or ADD medications.
J was frustrated by the tediousness of the process. She felt that much of the basic science content was silly and unreasonable, and was sure that no practicing physician even bothered to remember it.
“It’s basically malpractice if I decide to treat a patient with a supremely rare glycogen storage disorder based on the hazy memories of Step 1,” she said. “I would obviously look it up. This feels pointless.”
Whether my friends were all taking pointers from our schools’ academic advisor or she was just being prescient about the state of things, we stopped doing dinners. We stopped taking trips. A television break began to feel like a luxury item, only used as a reward for an exceptionally productive day.
I came home from Boston soon after the last day of classes this year, fully intending to stay a studious hermit, but desperately needing a change of scene. I had to get away from the mounting tension, the repetition and tedium that I now firmly associated with our library, and the incessant chatter about the test. I wanted to take it in the comforts of my hometown, small but familiar.
“You look so pale!” my mum said as soon as she saw me.
This was saying something, as I am Indian.
A week of R&R passed, and soon I found myself driving to the test center at 7 am with the brownbag lunch of champions. I was suddenly struck by the normalcy of everything: the greenness of the spring trees, stopping at the traffic lights, listening to pop radio. And the test experience felt really quick. A rapid 46 question set, five minute break, chugging of cappuccino, another rapid 46 question set, another break and so on. Before I knew it, I was done. For a few long seconds, I stared at my blank screen, frozen in disorientation.
I wasn’t sure what to do now.
Having been suddenly relieved of my magnificent, ever-present goal, I picked up my certificate of completion and stepped outside. What had I expected? Not exactly singing birds and trumpets, but perhaps some feeling of having run a marathon. Some exuberance. Some sensation that colors would be more vivid, lightness in my heart, a feeling of victory. But instead, I stepped out into a slight drizzle, and ducking under my hoodie, I scampered to my car and drove home through the slowness of rush hour. It was unbelievably anti-climactic.
My celebrations that night involved making dinner with my dad and settling down to watch The Descendants on Redbox. There was nothing of importance on the calendar. We were going to take a little trip in a couple days but the packing could wait. There was nothing I needed to do, no place I needed to be more than right there on that comfy couch with my piping hot Indian food. Unfettered time and complete normalcy.
It felt brilliant.
I asked friends for help titling this essay.
“Stop the Nonsense,” said one, referring to the mnemonic that a nonsense mutation encodes a stop codon.
“The USMLE Made Me Smelly, Or How I No Longer Had Time for Regular Showers,” was another.
Puns abounded: Falling OverBoard, Step by Step, Boreds.
But my absolute favorite: The Journey of a Thousand Miles Begins with Step One.