Tuesday, September 02, 2008

Pull up a chair

(Editor's note: this is maybe the longest blog I've ever written. It is very, very, very long. I apologize, but I suggest taking a bathroom break, pulling up a comfy chair, and maybe grabbing a snack. Here's the story, as far as I know it.)

Well, I had hoped to have a little more information on my situation before posting, but with Labor Day weekend and all, I couldn’t get any answers. So, I’ll tell you what I know and fill in the rest as it comes.

Here’s the synopsis, up to last week:

-I entered the PhD part of my MD/PhD career in July 2004.

-My first PI, Frank, moved to the Mayo Clinic in the fall of 2005. I tried to transfer, but there was no system in place to transfer me.

-Because of that, I had to pick a new lab. I had already done my qualifying exam in physiology, so it was easier to stay in the department. However, because of rules such as student ratios and funding, there was only one lab open to me in the department: Dr. B’s lab.

-I had rotated in Dr. B’s lab and didn’t want to go back there, but I didn’t have a choice. So in fall 2005 I started in that lab.

-I was told which project I had to do by an ass of a professor who is no longer at Case. He picked a project that he thought would move the fastest. It was a crappy project. I tried everything I could to get off the project. I at least tweaked it a little bit, but it continued to be a crappy, aggravating project.

-I wrote a paper on what I did in Frank’s lab in October 2006. The postdoc from the old lab generously (I thought) volunteered to be in charge of sending it out. It finally went out in May of 2007 to a journal that it had no change of getting into. It got rejected. So, we sent it somewhere a little more appropriate, but still reaching. It was rejected (though not torn apart), and we reformatted it.

-Because I was busy having a baby in October of 2007, the paper didn’t get sent back out until spring of 2008. It became a pattern that I would harass the postdoc via email continuously, he would drag his feet, and it would take months to get anything out. We heard back from the most recent place in June 2008. It was rejected, again, although two reviewers loved it and one hated it.

That about brings us up to this summer. Now, my current project sucks, and it always has, but my committee and my boss both constantly say, “A few more experiments, and you’ll be done.” The rule for graduation in my department is two first author papers, both accepted, before you can write your dissertation and defend. So, with how long that process takes, I knew that there was no way I would defend and be back in medical school this November. I was hoping for July 2009.

Well, in addition to having a crappy project, the lab ran out of money as a whole in May 2007. We lived off of the department until May 2008. And then we were totally out of money. We couldn’t fix broken machines, I had to beg or borrow for any supplies I needed, and all of the techs and research associates were let go.

I had my last committee meeting in June. I had called it because my support on the departmental training grant ran out, and my boss couldn’t pay me. I talked to all of my committee members individually about the issue. I also talked to a bunch of other departmental people. They all told me that finding the money wasn’t my job—they would support me. They all gave me this rah-rah speech about the end game being the hardest, just hang in there, etc.

Well, when my stupid experiments still weren’t working consistently, I decided to call another meeting last week. Here is what I emailed out:

Hello. I would like to schedule a thesis committee meeting as soon as possible. I’ve included the best dates and times below. The focus of this meeting is not primarily on my scientific experiments (although I will give an overview of where we are). It is more to talk about general issues such as lab space, projected dates and funding, and the dreaded “plan b”. Specifically, Dr. B and I have been discussing the following issues:

  1. Dr. B’s lab is closing in the near future. It is currently only Dr. B, me, and a fellow in the lab. We have discussed that I would benefit by moving into a more active lab sooner rather than later. This would not involve switching projects, but physically moving into different space.
  2. I am still struggling with antibody issues. I’ve had some results that look positive, but repeat experiments are inconsistent, even under the same conditions. I’ll talk about what I’ve tried and where I am with things, but we need to discuss what else to try to finish up my current project.
  3. The last, and largest, issue is to talk about my projected path. It is obvious that finishing the PhD in time to re-enter medical school this November is not an option. We need to figure out: how long physiology will fund me; what else I can do to expand my thesis; and what are the potential hurdles I face. Part of this discussion is “plan b.” As I mentioned at my last meeting, my goal is to finish my PhD and return to medical school. Despite all of the frustrating speed bumps I’ve hit in my PhD, I still have an interest in research. I feel as though my thesis is my baby of sorts, and I would hate to abandon it, especially after so much hard work. I am frustrated that so much of what I have done hasn’t worked, and I know that non-productive experiments don’t progress a thesis. But I have worked very hard to get this far, and I am committed to working hard to doing whatever needs to be done to finish.
At the same time, I think we need to have an honest and open conversation about worse case scenario. I am quickly approaching November—if we need to use “plan b” and send me back to medical school without completing my PhD, I’d like to decide that sooner rather than later. Getting back to medical school in November means I graduate medical school in 2010. Waiting after that puts graduation at 2011.

Again, I’d like to say that I don’t want to abandon the PhD. But if the issues mentioned can’t be resolved, I at least need to know what my options are.

So, if we could plan to have a conversation about these issues and others, I’d appreciate it. I know much of this was discussed while I was out of the room at my last meeting, but I’d like to be a bigger part of the discussion this time.

I know this is short notice, and I know it is bad timing with the start of the fall semester. I really apologize for that. But if you could make it to any of these times, please let me know. You can either tell me your preferences for times, or let me know if there are times you CANNOT make it.

I really appreciate all of your help with this. Please bring any other thoughts or concerns with you to the meeting. I’ll let you know as soon as a consensus on timing is reached.

I got good feedback about the email. I even had an offer from a professor across the hall—who wasn’t even on my committee—for lab space and stipend support until May. Talking to Dr. B, it sounded like the plan would likely be that I take my current project and move into a new space to finish up.

I knew that there were several other scenarios that could play out. And I had a long talk with Tim, God, myself, and anyone else who would listen about what each of those scenarios would mean. Ultimately, I decided to just let go and trust that the right one would work out, whatever one that was.

We had the meeting last Wednesday. As is typical, the meeting begins by me leaving the room and the committee discussing amongst themselves. At my last meeting, they did this for over half an hour. Even though I expressly said in my email that I wanted to be a bigger part of the discussion, they took another half hour to themselves this time.

I went in and gave my overview of current data results as well as my questions. A few of my committee members asked me some scientific questions. Then they asked me what I wanted to do about my situation. My goal was to finish out this crappy project, get my second paper, take the time I had while I was waiting for my paper and start a better project (in a related, but not exactly the same, area) that I could use as a chapter to my thesis even if it didn’t turn into a whole paper. Then I could defend and go back to medical school July 2009, which graduates me in 2011.

This was along the lines of what my committee had been telling me—just finish this up, write it up, and then flesh out the dissertation a bit with either other unrelated projects I’ve already done or something short-term.

I waited for their response. And I didn’t like what I heard.

They all agreed that the lab was not a good environment for me. However, they also didn’t think the project was worth keeping. I’ve been having antibody issues for ages, and they made the comment that even if I get the antibody to work, there’s no guarantee the science will work the way I want it do (Duh, that’s why they call them experiments). So, since there were no guarantees on the project, they thought it was best to just abandon it.

They said that left me with two options: move to a new lab and start a new project, or “cut bait” as it were and go back to med school.

If I started a new lab, there would be no guarantees on my time. It may take me another three years to get a project completed—and really, that was if things went well. And I would be limited in my choice because I needed a physiology lab with enough money to support me. Considering we have lost 60% of our faculty since our former department head left in 2005, that is a tough sell. No one has funding.

Or, if I went back to medical school, I could basically write up what I have, get a master’s, and go back in November. Of course, I would be footing the bill. Which means I go from making $20,000 a year to owing $43,500 in tuition (plus cost of living).

My committee said time and again that they were thinking of my best interest. It was their recommendation to go back to medical school.

I was in a bit of shock. Prior to my meeting, I would’ve put the odds at 90/10 finish the PhD/go back to med school. Nothing anyone had mentioned indicated otherwise. And yet, in half an hour, they had decided this.

They did say that if I wanted to commit to another lab, they would support me. But they mentioned that three labs with three projects totaling 7 or 8 years of PhD alone is a lot to ask of anyone.

I was hurt, but I held the tears in. I told them that I appreciated their honesty, and I would think about it and get back to them. They all had some very nice things to say about me—especially Dr. B, who is the last person on earth I would have expected that from. He went on for a long time about how hard I work and how committed I was. He said he would’ve given up a long time ago. No one said any of this was my fault; in fact, they went out of their way to say it wasn’t.

It’s hard to believe that though. I mean really, they are asking me to give up on my PhD. I’ve slaved for four years—and they want me to walk away? And of course, I am thinking of all of the people I know who have gotten their PhD with much less sacrifice (and not great science, either). I’m immediately feeling like a failure.

My committee dispersed quickly. Dr. B had to go teach a lecture, which was just as well because I wasn’t ready to talk to him. My committee chair hung around and tried to give me a pep talk about how “science is luck” and “only 50% of students make it.” If that 50% number is supposed to make me feel better, he failed miserably.

Margie, one of the professors on my committee, hung around for a while after. She had been a postdoc in Bill’s lab when I was an undergrad, so I’ve known her for almost ten years. When it was just her and I, we both lost it. We’re both crying—she feels terrible, I feel awful. She only joined my committee six months ago. She told me when she joined, she couldn’t believe my committee had let my lab issues go on that long. She felt like they failed me.

I feel like everyone failed me. I had two programs responsible for helping me succeed, and neither one had my back. MSTP couldn’t support me financially, but they could’ve put pressure on people. And physiology is supposed to help me be successful. Instead, they were the one that put me into this situation when Frank left.

After the meeting, I ran into one of the other PIs. She said that I should fight—I should call everyone I know and complain. She said it isn’t my fault that the department is falling apart, that I ended up in a terrible lab (she had some very choice things to say about Dr. B), and that my committee let it get to this point. In theory, I agree with her. However, I know I am not the only student that had had this issue. The department guidelines are very clear. If they make an exception for me, there will be 30 students in line behind me asking for their own exceptions. I understand why physiology can’t do that. But it doesn’t mean I like it.

And I’m tired of fighting. I’m worn out. Being in constant lab drama for four years has just broken me. If everyone is giving me a pass to leave, I want to take it. They all said positive things, and I think they would all write letters of reference in my favor at this point. But if things are so positive, then why can’t I finish?

I haven’t had a lot of anger, but I’ve had a lot of sadness. I know that mentally and emotionally, I can’t do another lab switch. I still have no guarantee on time—who’s to say that I won’t have the same situation three years from now? That leaves me with going back to med school. Really, I feel like that is my only option.

I have so much going on with me right now. I had this same decision to make when Frank left in 2005. I decided to stay, mostly for two reasons: pride and money.

I’m not proud in the sense that I am pushy or boastful (or at least, that’s how I feel—I could be wrong). I’m proud in the sense that I can’t let people tell me that I can’t do something. When Frank left, I had only been in the PhD a little over a year. I felt like I didn’t know for sure if I wanted to do research or medicine. I didn’t have enough experience in either to make a guess. And I knew I’d probably get one paper out of what I had done. How long could it possibly take me to get another paper in another lab?

Plus, I didn’t want to walk away from the stipend and start having to pay for school. I figured things would work out. So I went into Dr. B’s lab.

Here I am, three years later. I have to abandon my pride and my stubbornness and do exactly what I didn’t want to do three years ago. And what do I have to show for it? Three of the most miserable years of my life. The lab has been hell on earth. The sacrifices I’ve made, the weekends and other hours I’ve lost on a project that didn’t work. I’ll never get that back.

But, I told myself before my meeting even started that I would accept whatever situation resulted. If it’s taken three years of misery for me to realize this isn’t my thing, then so be it. I am terribly pig-headed. If nothing else, this is a good life lesson.

Of course, I’ve already started stressing about the emotional ramifications. I’m no longer an MSTP student, or a physiology student. I’m “just” a med student. As Tim put it, being “just” a med student is hardly inconsequential. But when I’ve had six years of people oohing and aahing over being an MD/PhD student, it’s hard to accept that I now have to tell everyone I know that I have failed. I’m not going to be a doctor/doctor. I won’t have that PhD that I was hoping to celebrate next year. And I’m going to have to relive it over and over again every time I run into someone I haven’t seen in a while.

“How’s your PhD? When are you going back to med school?”

“Well, I decided to drop the PhD and get a master’s degree. So I’m going back to med school in November.”

“Why? What happened? What about tuition, and getting a good residency/fellowship, and . . . "

The list goes on. And I am going to have to have that conversation over and over and over again.

Ultimately, it’s just losing my pride, sucking it up, and telling the truth. It’s going to be an ego bash every single time, but again, maybe that’s the life lesson.

The money is a different story. While the pride is just emotional, the money is a very real concern. We had a baby because we made room in the budget for day care. We bought a new house because we made room in the budget for the mortgage payment. We’ve made every money decision based on two incomes (although mine wasn’t much). There are some things we can cut out of the budget—our one monthly splurge, satellite TV for $60 a month, may be the first to go. But we’ve always lived frugally. There isn’t a lot of fat to trim. If we had known I’d be paying for med school, I’m sure we never would’ve bought this house, and we probably would never have had a baby. But we can’t really take either of them back—not that we’d want to. I’m sure in this market, selling would mean a huge loss, which is an additional financial liability in itself. And I wouldn’t trade Sophie for anything.

The loan, while sucky, isn’t the end of the world. If we live frugally for a few years once I am practicing, we can pay it off. I’m worried about getting the cost of living money covered by the loan. We need $1000 a month for daycare and baby expenses. We could let the rest go (somehow…). But the med school website says that if the med student is married, they expect them to cover all of the living expenses. Plus, they may even expect us to kick in a little money for tuition.

This is where I haven’t gotten any answers yet. I’ve sent some emails out, both to the registrar about returning to the curriculum and to financial aid about the loans. There are still a lot of ifs out there. I’m hoping to have more answers soon.

I’ve so far only managed to tell some people at school (basically, Kim plus whoever ran into me in the hallway after my meeting) and our immediate families. We had dinner with my parents on Wednesday night, and dinner with Tim’s parents on Thursday. Basically, they want to beat the crap out of everyone involved. It’s very sweet how protective they are of me. I think they understand my fears pretty well. They are doing their best to be supportive.

Tim’s been great too. He was most worried about the money, but once I explained about the loans, he’s calmed down some. We’re also a little stressed about if and when we’ll have another baby. The thought had been to have the next one January 2011 or so—a little over 3 years apart. That way, the baby would be 6 months old when I started residency. And hopefully I’d have some free time in 4th year to spend at home. Now, we’ve either got to bump that up to January 2010—a date a little too near in the future for us—or wait until 2012 (I do not want to be pregnant during my first year of residency). 2012 means Sophie is 5—that’s a bit more of a gap than we want. So, that’s an entirely different issue we need to resolve.

I’m hanging in there. Besides the initial cry fest I had with Margie after the meeting, I’ve been pretty stoic. When life events happen, I either go into crisis management mode, or I have a total freak out. The crisis management happens much more often (unless I am pregnant, then it’s freak out time). And that’s where I’ve been—making lists, developing plans, and trying to be rational and calm. I’ve had a few moments of despair, little to no anger, and most of the self-pity/anxiety I’ve been able to hide under the surface pretty well.

I know I’ll need time to mourn all of this sometime in the future. But with November coming up fast (and hopefully starting in October, if I can swing it), I’ve got to get things figured out. I can have a nice pity party sometime in the future.

I guess that’s it. I’m going to ask a few more people for suggestions, but barring some kind of miracle, I’m going to quit the PhD and go back to med school.

It’s going to be tough, but there is a part of me that’s happy to at least have a plan. So much has been in limbo during the PhD, and up until this last meeting, I feel like I’ve never been able to get straight answers. This is going to be tough for a million different reasons. But I have to ask myself: twenty years from now, is this going to be a big deal? I am counting on the answer being no.

Sophie’s been sick and fussy the last few weeks, so Tim has been staying home with Sophie while I go to church. This was the first week in a while we all went together. We were sitting in the cry room when the homily started. The priest started by saying, “Have you ever felt like life was unfair? Have you ever done your part, fulfilled your responsibilities, and not had things work out the way they were promised?”

I looked at Tim, then I looked up. “Ok, I get it,” I said.

Tim thought it was actually a bit creepy how much the sermon applied to me. The punch line was that things don’t always work out the way you want them to, but everything happens for a reason. If you stay on the path, despite all of the injustices that come your way, things will work out in the end.

I’ve got a lot of questions I need answered. And my first one to everyone I talk to will be, “Is there any way I can salvage my PhD and be done in a year?” I figure it’s a long shot, but it’s worth asking.

If the answer is no, which I expect it to be, then I will move ahead with planning to go back to med school in November with a mountain of loans.

I’ve had a few freak outs this weekend (things like, “I own two pairs of dress pants and one nice shirt. How am I going to be able to afford dress clothes before med school starts?”). They’ve been mostly inconsequential, but last night I didn’t sleep at all. It wasn’t so much anxiety about the med school issues. It was knowing that I have to come back in and face my committee members—and my boss. I’d be happier just walking away and never seeing any of them again. But that isn’t a very adult way to handle things. I will hopefully talk to more people and get more answers in the coming days. For now, you know as much as I know.

2 comments:

  1. I am so sorry that you have had such a crappy three years! I will be thinking of you while you try to transition back. I know that you will LOVE med school!

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  2. good luck with everything - and don't worry at all about getting a 'good' vs 'bad' residency. that has nothing to do w/ a phd, just with working hard and showing your interest in medical school. even though it hurts that others had expectations of you, just do what you want to do. i think you will be so happy seeing patients, and the money stuff will fall into place eventually.

    plus, it's not 'just' a doctor. it's still a huge and awesome career! no shame in that whatsoever. although i think there is no shame in any career that provides satisfaction.

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