How to really be the biggest loser

It has been a month or so, and I am starting to take solid food again. The sackcloth is board hard with dried filth. I am ready to rejoin the world again, although now reborn as a lower life form. I have tried to be honest about the ramblings I post here – which I clearly recognize to be an egregious example of amateur writing in the service of self-stimulation (to be polite). But I have written about my clinical specialty board exams here in the past, and it would be wrong not to tell the rest of the story on my blog, so here goes.

The first time fail rate in the oral boards of residency trained examinees is 3%. That puts me in the bottom 3% of my class. I failed. I am humbled most sharply. I was being facetious in that first paragraph above, but really I did have nausea for about a week. A terrible sense of gloom seemed to roll out of that large, hopeful looking white envelope. That cloud has been the shroud I have worn at work ever since in place of the usual starched white coat.

Of course I am over dramatic. My both my wife and my mother would be the first to agree that I tend to be so, but hell, this really sucks! I don’t know anyone else who failed this last, oral exam for board certification. I thought of people that failed the oral exam just as I thought of people killed by a freak tornado strike. Extremely unfortunate, but not likely to happen to me! I am the statistic – me and the rest of the emergency medicine side show freaks that get bounced on the LAST TEST after passing every other hurdle in a medical career (MCAT, medical school, USMLE 1, 2, 3 and the written board exam).

So, what the f*ck went wrong? Did I study? – Of course. Did I have the right books? – The Rivers’ series carefully gone through. Did I practice? – Yes. With audio tapes and with an expensive professional tutor over two days in Chicago, I did. Did I take a review class? – No, I thought two days one-on-one with a tutor was even better than a class. I also got a good night’s sleep and had a good breakfast. I got there early and wore my suit. I even had clean breath and underwear. Maybe I should not have worn my school tie?

Did something weird happen? I couldn’t say. I am sworn to secrecy by the board. I take full responsibility. I will (hopefully) get to retake. I will take a standard class to prepare. Thankfully, my work understands and really my status does not change as long as I am still eligible for the boards. My immediate boss is very supportive. What a drag though! It makes work very much harder when you feel like a complete loser who does not know anything.

So maybe this is a sign. Maybe I do not need to be doing emergency medicine. I spoke to my brother at Christmas about laser tattoo removal. Maybe that is way to go? Set up a little business? Cash business with good hours! I had an attending that went away for some time to “do veins” in some varicosity practice – I think. He came right back! I should talk to him, but I have not yet.
But, what is really important for the long haul? Maybe an examination is not. Maybe a baby daughter and a better world are? What the blog was supposed to help with was thinking about the practical prediction of violent social behaviors. To guess at an explanation of why and when wars war and fights happen. I have been distracted professionally and personally, and for good reasons. But riddle me this Batman… will science eventually predict the emergence of the phenomena of war based on initial conditions?

A great news story on BBC today gives reassurance that wars (like storms and earthquakes) can be predicted – to some extent.
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This was important to me because I remember distinctly being a young teenager when war broke out in the Falklands. I remember reading in the Birmingham News about the sinking of the Atlantic Conveyor by an Excocet. I was a British child in Alabama in 1982, a subject of Her Majesty. And to suddenly hear that the U.K. and the SAS were shooting real bullets in this hemisphere blew my mind. It seemed that war sprang out of nowhere, completely unpredictable. But, of course, that is not the case.

A theme that has always interested me is the unexpected arrival of war. We are always so surprised when bombs start going off, but it is so predictable when they go off.

So, I failed a stupid exam. It is not like I drove my Humvee over an IED.