You get what you need

It was a sunny spring day in 1995, and my spirit was about to be crushed.

He was our college health careers advisor, a doctor who didn’t go by ‘Doctor’. Rather, he was ‘Dean’, as in Dean of the Pre-Meds. His office was in one of the older buildings overlooking the college green, and there I sat in his wood-paneled waiting room, shifting around on a very uncomfortable antique bench as his most loyal secretary guarded his door. That’s how he introduced her, an offhand comment as he ushered me in: “…and this is Lisa, my most loyal secretary”. She smiled thinly as she typed, never looking up from the screen.

I needed– no, I required his blessing. The Dean’s Letter of Recommendation, with its succinct summary of grades and accomplishments, was the final checkbox on the list of Must Haves for medical school applications. I walked into his office confident, but I had no right to be. Yes, I’d been a top student in high school, without trying very hard. Lots of late-night skimming and last-minute cramming. But relying on those ineffective methods at an Ivy League college had had predictable results. “Doesn’t apply herself” was pretty consistent feedback. Sure, I did some smart, cultural, and altruistic things. I was a lab tech for a quirky neuroscientist and teaching assistant in an advanced psychology course. I spoke Spanish and had spent summers in Guatemala with family for many years. I’d volunteered at all the hospitals. I wasn’t worried about my B grades and average MCAT scores. I was far too interesting a human being to worry much about those irrelevant details. 

“I understand that you’re considering applying to medical school,” he began. 

Considering?

I collected my thoughts and plowed forward. “Yes it’s my dream, my father is a doctor, his office is in our house…” I went on to describe how close I’d been to clinical medicine all my life, trying to sound convincing about how natural and logical it would be for me to become a doctor, too.  

He inspected my transcript. “Hmm… Double major in psychology and comparative literature. Can speak and read Spanish, interesting. Excellent grades in the humanities,” he nodded and smiled. But then, raising his eyebrows: “Hmm, a ‘C’ in physics. A ‘B minus’ in organic chemistry. A slew of ‘B’s’….” He looked up. “I’m seeing mostly B-level work in the premedical prerequisites. Those topics don’t interest you as much, do they?” 

Don’t interest me? I love rat lab, the brain is awesome, science rocks… My mind in noisy protest, I sat, silent. 

“Monique, I’m sure you’ve considered this already, but given your academic performance–” he closed my folder, pushing it away from him on the desk– “I’m concluding that perhaps medical school is not your intended path.” 

Not my intended path? My brain was processing what he was suggesting and maintaining maximum denial at the same time.

We sat, silent.

He cleared his throat. “Have you considered a physician assistant program? It’s not as… rigorous. If your interest is actually in taking care of people, being a physician’s assistant could be a good fit for you.” 

I blinked. A WHAT?

“Or, if you really think you want to help people and you’d like to test out that hypothesis with less of a commitment, you could become a paramedic for a year, see how it feels on you, witness the human drama, smell the body fluids…” He sniffed. 

I breathed. 

He brought his fingertips together and smiled politely, regretfully: “Monique, the truth is, we have many excellent premedical students, more than we can possibly endorse. We can only recommend our top students.” Here he paused and leaned forward: “You are not a top student. Therefore, I cannot write your letter.” 

I didn’t move. I couldn’t speak.

He sat, tapping the desk. 

“Hmm. You’re Guatemalan, you say?” 

I nodded.

“Well, that’s too bad. If you were from one of the officially underrepresented Hispanic groups, say, Mexican, or Puerto Rican – mainland Puerto Rican, that is – you’d be a star. I’d be thrilled to write your letter, were that the case… But it’s not.” He shook his head sadly. “I’m so sorry, but I’m sure you’ll find your way.” 

He gestured to the door, as if to say, he was sure I’d find my way out the door. 

I stood up, stifling sobs. As I left, Lisa his Most Loyal Secretary pointed to the box of tissues strategically placed on the far corner of her desk closest to where I would be walking by.

“Please feel free to take some with you,” she offered, her tone casual.

The gesture was intended to be kind, or at least to appear kind, I’m sure. But it came off as dismissive, like: And here’s yet another pathetic underachiever being booted into reality...

I sobbed all the way to my boyfriend’s apartment. He and all of our friends were pre-med. They all applied themselves, they were all on the honor roll, and they knew all along that I wasn’t going to get that letter of recommendation. And I should have known as well. 

As indignant as I felt and as hysterical as I got, that Dean did me a favor. I was finally getting it: Half-ass wasn’t good enough. And the consequences of my own laziness required a complete change of plans.

I had choices to make, and the resources to make them. There were serious conversations with my parents, who could support a fresh effort. They had expectations of me, and I was hell-bent on proving that Dean wrong. Pride and spite are powerful motivators. We decided to go all-in.

This was pre-internet, so I reached out to my professors, friends, anyone. What do people like me do next?

They do a post-baccalaureate pre-med program is what they do. Which I did. I drove myself to Philadelphia and moved into an apartment with a bunch of girls I didn’t know, our only commonalities being a healthy fear of our sketchy West Philly neighborhood and a strong mutual dislike for each other. During the days and weekends, I worked in a series of medical-adjacent jobs, so I could cover some of my expenses. I was a veterinary technician in charge of cleaning cages and shaving fur; a research assistant for an HIV vaccine trial in Fishtown; a home health aide for a Main Line woman with spastic quadriplegia. During the evenings I carried a full load of heavy science classes, studying alongside grimly determined super-competitive second-chance pre-meds like me. It was intense and exhausting. I dealt with all kinds of literal and figurative shit all day long. I fought with my roommates and my classmates. I barely slept. I ate like crap. I got mugged.

I got all A’s.

It was a lot of saltines and butter, sometimes scary, and mostly miserable, but I learned more that year running around crazy working-by-day and studying-by-night than I ever did as a coddled undergraduate with all sorts of free time. The experience set me up to excel in med school, survive residency, and endure the uncomfortable, unglamorous, unbalanced reality of practicing primary care medicine for years and years.

Which, on second thought, maybe isn’t a good thing. After all, the medical system relies on the hardworking professionalism and willing sacrifices of healthcare providers. But that’s an essay for another day… soon.

Meantime, the message here is, you can’t always get what you want, but you can get what you need. And sometimes, we need one door to get slammed in our face so we can figure out how to open another one.