When I was a child, one of my favorite songs was “Count Your Blessings.” The first verse of the song goes:

“When upon life’s billows you are tempest tossed,
When you are discouraged, thinking all is lost,
Count your many blessings name them one by one,
And it will surprise you what the Lord hath done.“

Have you ever had your heart broken? Felt your mind shatter into a thousand small pieces? Your soul’s legs give way from under you? Have you ever put all of your effort and energy into a task only to see it come to a fruitless end? Or looked ahead into the future and seen nothing but a murky, swirling abyss of uncertainty and confusion?

On Wednesday December 13th, I was in the middle of my final General Surgery interview when I received the email that all military fourth year medical students had been waiting for. This missive would determine where I would be spending the next five or six years of my life. The clock struck noon, a few minutes ticked past, and my Outlook mail tab blinked the familiar notification of the new email. I took a deep breath, clicked on the email, and read:

I stared at that message, my brain refusing to believe what I had just read. Despite its very congratulatory tone, it was not, in fact, the results I had been expecting. I had applied to, and interviewed for a General Surgery spot. I had not, in point of fact, matched to any General Surgery positions. I was going to be a Transitional Year resident, which meant I was going to spend my next year working as a general intern, and reapplying for residency. My choices will consist of matching into a Categorical General Surgery position, which as I have been able to gather so far is exponentially harder for someone in my current situation, or going into a General Medical Officer position, which implies I will be appointed somewhere to serve the Army for four years, after which I will be able to reapply for residency. This second option almost guarantees that I will not become a Surgeon, given how far removed I will be from my fourth year of medical school and the application process.

The military match, just as with the civilian match, usually has certain specialties for which there are always more students than spots. Surgical specialties are an example, and given the competitiveness of the students who usually pursue these specialties it is always best to enter the match understanding that one might be a Transitional Year (TY) resident. I was, to some extent, prepared for that. What I was unprepared for, was the location I was being sent to. Madigan Army Medical Center. In Washington state.

Anyone who has ever heard me speak about life after medical school knows that my one wish was to be close to home. I have been away from my family for almost seven years now, and all I wanted for residency was to return someplace close enough to make it easier to spend time with them. So I concentrated my efforts on army medical training facilities (MTFs) close to home. The complicated beauty of residency application, however, is that as with everything else not under one’s control, one should hope for the best and expect the worst. I hoped to match in one of the locations I had ranked high on my list. I opened myself up to the possibility of being a TY resident, thinking if nothing else I would be placed somewhere I had actually hoped to go. I got placed in a spot I had ranked next to last on my list, listed as such due to the simple fact that I knew nothing about the area, it was the furthest from my family and at the time I had no intentions of moving that far away.

I had seen a message like this previously. A friend of mine who was just finishing up his TY sent me the email he received the prior year, so I had known not to read too much into the first word of the email. The rest of it, however, slowly shattered my heart. I know that every fourth year medical student works their hardest during this season to find a residency spot. As sad as I felt about myself, I could not help but be happy for friends of mine all over the country who had put in months of work and waited with hearts in mouths for the past few months just as I had. I understand firsthand the meaning of setback and disappointment in the face of hard work. It took six years of a previous career during which I underwent three medical school application cycles and a Master’s program to finally get accepted to Medical school. Getting my Bachelor’s degree took me six and a half years instead of the conventional four. I am no stranger to the concept of falling, then rising, dusting one’s self off and trying again. I am no stranger to the concept, but that does not make it hurt any less.

I spent the first few hours of that December 13th afternoon moving swiftly through the five stages of grief. I wondered what exactly I had done wrong. I knew what my faults were as a person, and I knew the mistakes I had made on the interview trail. I turned them over in my brain, trying to recall anything I had done that could have cost me a spot in a residency program-did I do too much? Too little? Was I too friendly? Not friendly enough? Was that incident with that one circulator really that bad? Was I supposed to let myself be treated like I did not deserve to be where I was and take it without comment? Had I been too critical of myself? Of other people? Were my scores not good enough? Had my letters of recommendation not been strong enough? Should I have disbelieved every resident and attending who had told me I was an excellent student and would make a good surgeon and a great addition to their program? If the answers to any or all of these was no, would it have mattered? There was no way to tell. It had happened, it was done and there was nothing I could do about it.

I am no stranger to the concept of failing. The familiarity does not make it hurt any less. The thing it does allow me to do, however, is to look back, see how far I have come, and enumerate all the wonderful things that have come my way as a result of this journey.

The second verse of that song is as follows:

“Are you ever burdened with a load of care?
Does the cross seem heavy you are called to bear?
Count your many blessings, every doubt will fly,
And you will be singing as the days go by.“

I am a firm believer in the silent Hand of God ordering our steps in life. I have spent the last week coming to terms with the fact that my new home, for at least a year, will be on the opposite side of the country, away from my family and the people I care about. Certain events over the past few days have led me to reaffirm my trust that this new venture, however uncertain, is exactly where I need to be in life at the moment. I have also spent the last few days looking back at all the blessings I have been favored with this year. To name a few:

• My incredible fiancé (the best answer to my prayers!)
• A whirlwind trip to Canada… (and the sweetest/nerdiest proposal I could ever have imagined!)
• …And another to Puerto Rico (to celebrate my badass sister and my awesome brother-in-law)
• Great feedback from superiors on my auditions (I will always be grateful for everyone who said I will do well as a Surgeon-it meant the world for someone who only decided on Surgery halfway through my third year)
• Amazing friends and family (who have blessed me with incredible conversations and great memories)
• Madigan Army Medical Center (An attending I admire very much told they saw me as a resident at an institution such as this. Maybe God really is writing straight on crooked lines)
• Washington state (According to information from classmates and friends, this is an absolutely gorgeous state, and as outdoorsy people, we are going to enjoy our time there-this one remains to be seen, but I am counting it anyway)

The final two verses of the song above are as follows:

When you look at others with their lands and gold,
Think that Christ has promised you His wealth untold.
Count your many blessings, money cannot buy
Your reward in heaven, nor your Lord on high.

So amid the conflict, whether great or small,
Do not be discouraged, God is over all;
Count your many blessings, angels will attend,
Help and comfort give you to your journey’s end.

In a year filled with hard work, stress and heartbreak, I have also found joy, fun, happiness, and endless outpourings of love. To say that I am blessed beyond measure is an understatement. I have no idea what my next year is going to look like. All I know is God holds me in the Palm of His Hand, and makes Everything Beautiful in His Time.

PS: For anyone who wants to listen to the song, here is an upbeat version: https://www.youtube.com/watch?v=PQjKkbG_pgk

Happy Holidays to all, and a Prosperous New Year in Advance!