A feeling of panic overcame me as I sat at my desk, where my sole existence had been for the past several weeks. Putting down my phone and taking a sip of water, I attempted to get back to my studies, but my mind was racing. And before I could process what was happening, I began to cry, violently sobbing alone in my room. It took several minutes before I regained control over my own body. It was June 2020, and I was just one week away from the United States Medical Licensing STEP 1 Exam, arguably the most important exam for medical students when applying for residency (and beyond, at least for my class – who still received a numerical score). In the “before time,” what we call life before the COVID-19 pandemic, second-year medical students gradually retreated into their studies for several months before the big exam, which eventually culminated in a six-week dedicated study marathon known simply as “Dedicated.” This time period often entailed 12+ hours of daily studying, seven days a week, laden with stress and isolation and uncertainty, to say the least. Now, with the added layers of an international pandemic on top of societal trauma to the American psyche, morale was at an all-time low. Taking a break amidst my studies, I had just read yet another article commenting on the bleak situation engulfing the United States; I quite honestly cannot remember what the tragedy du jour was. News articles seemed to report more bad than good, aptly inspiring a new term – “doom-scrolling” – to describe the endless newsfeed of negativity and despair. I had also made the mistake of checking my social media, where I was met with an inundation of social unrest and calls-to-action from my peers. And it was then, as I sat in my pajamas, sheltered at my desk with my books, that I completely lost it. The delicate wall of emotional protection I had carefully built collapsed instantly from months of weathering. To this day, I still struggle to identify what had struck me the most: the stress from the exam and uncertainty over my future, the health of my loved ones, or the general state of the world. The COVID-19 pandemic has rapidly transformed not only the field of healthcare, but more importantly, the world at large. The public eye has focused mainly on the ongoing impacts regarding physical and mental health of the entire population, with some attention being given to healthcare workers, and even less attention to healthcare students and trainees. Although not yet having seen the frontlines, pre-clinical medical students have been caught at an especially precarious time. From my own experiences, I often felt guilt for attempting to tune out the horrors of the world in order to get through the day. I felt inadequate for sitting on the sidelines while my peers within the realm of healthcare were risking their lives. I felt selfish for temporarily retreating from the social discussion over injustice in this nation. As of mid-July 2020, over half of American adults have reported a negative impact on their mental health due to COVID-19. This takes the form of sleep disruption, appetite changes, substance use, and strained relationships, among many other things. [1] Mental health in relation to the pandemic has also been explored in healthcare workers, a particularly resilient population who is now experiencing increased rates of anxiety, depression, and other psychological effects, beyond their physical health risks. [2] The literature dwindles even further when exploring COVID-19 mental health effects on healthcare trainees, specifically. One such study surveyed medical students in May 2020, which “demonstrated a higher prevalence of moderated and severe anxiety and depression symptoms among medical students during [the] COVID-19 pandemic.” [3] This is alarming when understood in the context of the already rocky psychological health experienced by medical students in the “before time.” Perhaps we are fortunate that mental health destigmatization and open discussion has been gaining prevalence within the last decade, well before SARS-CoV-2 became a household name. But there is still much progress to be made, particularly for healthcare workers who exist in a culture that “reinforces the belief that physical and emotional exhaustion is part of the job.” Vulnerability and needing help are often viewed as signs of weakness that must be internalized. [4] And, once again, what about the medical students? A cohort who often feel they have no grounds to articulate their struggles when there are “real clinicians” who appear to cope with their stressors, at least on the outside. When taking into account the status quo of emotional silence within medicine, trainees are taught to mask their struggles just the same as they are taught cardiology or histology. The system of medical education must continue to make strides towards trainee and clinician wellness, adopting a proactive approach rather than reacting when the going gets tough. My own medical school sends monthly wellness emails that normalize the emotional and mental struggles students experience while encouraging the utilization of resources, including free therapy. But students themselves must continue to be proactive, checking in on peers but also checking in on ourselves, lest our delicate emotional walls come crashing down in one fell swoop. Everyone – not just healthcare workers and trainees – is experiencing a period of history in the making; we will one day be the protagonists of novels about this transformative time. But in the meantime, we must be kinder to ourselves and ask for help when it is needed. We must catalyze the continual progress being made regarding mental health to pave the way towards a stigma-free future. [1] https://www.kff.org/coronavirus-covid-19/issue-brief/the-implications-of-covid-19-for-mental-health-and-substance-use/ [2] https://intjem.biomedcentral.com/articles/10.1186/s12245-020-00299-5 [3] https://www.medrxiv.org/content/10.1101/2020.06.24.20138925v1 [4] https://www.nejm.org/doi/full/10.1056/NEJMp2024834

I firmly believe that we are who we are from the experiences we encounter every day of our lives. Each experience molds our character, our views on the world, and our understanding of our role and our purpose. Each person has their own story to tell and their own path to becoming the person they are today. Only with reflection over time can we truly appreciate the relationships and events in our lives that have played such vital roles in these stories. One such relationship in my life has been with my maternal grandmother - "Mama." Born and raised in Hungary, she fled with her family as a refugee when she was only a teenager during the Hungarian Revolution of 1956. She found a home in the Hungarian community of New Brunswick, New Jersey, met my grandfather (another Hungarian refugee), and thus started my roots in New Jersey. Mama had always been a fiery, brave, and selfless woman - truly our rock, our matriarch. My grandmother had always been sick during my childhood; it wasn’t until I was a young adult that I understood what exactly she suffered from: Hepatitis C. They suspect she had been infected as a child in Hungary via un-sanitized medical equipment, with the disease manifesting while she was in the US several years before I was born. When I was just 4 years old, in the year 2000, Mama was at death’s door, the disease taking its toll. But she was fortunate to receive a second chance at life: a liver transplant. With this medical miracle, I was honored to have her in my life until 2008, until I was 12 years old. I was honored to get to know the fierce, brave, and selfless woman she was, a woman who's spirit I take after to this day. This sort of medical advancement introduced me to the powers of medicine and mankind: to reunite loved ones. It dawned on me that giving the gift of life is a privilege and an honor that only physicians can bestow upon others. I have since aspired to serve others in this way. Featured here is perhaps my favorite photograph of all time. Captured in June 2001, with the cake reading: “A Celebration of Life with Family and Friends. Happy 1 Year!” One moment from a backyard gathering, we celebrated one year after my grandmother’s liver transplant. Featured is Mama, cutting the cake, and myself, just 5-years-old.

The system of medical education in the United States - and medical system at large - is undoubtably broken in this day and age. Although the cause of this broken system is multifactorial, one downfall is cited again and again as a perpetuating factor within a vicious cycle that antagonizes unfair expectations with even more unfair solutions. It is the “norm” - the expectation, the so-called “investment” - that medical students will pay between $40,000 and $60,000 a year to pursue their passion, after spending similar sums in order to achieve the prerequisite undergraduate degree. To pursue a lifestyle with high burnout, many sacrifices, and even a disproportionate rate of suicide when compared to the general population. This leads us to the current predicament: the average medical student will graduate with $200,000 in debt, snowballing with interest so that the true sum owed is even greater. And the true sum owed extends beyond monetary value, enveloping years of one’s life and youth. So what is the solution? These students are told that they can pursue a career within primary care, a workforce that is so desperately needed in this current medical system but is only compensated modestly, when compared to the profession as a whole. Or they are told they can subspecialize within a more “competitive” specialty, so that they can be paid handsomely. With these options, what becomes the driving force? The idealist might say “passion” and “interest.” But every medical student in America knows that the ability to pay off your loans while attempting to build the life you postponed becomes the true motivation. And this becomes the bottom line of our broken system. Before starting medical school, I knew I wanted to incorporate Women’s Health into my future career. In this sense, the field of OB/GYN has always been of intrigue. Through more experience and exposure, I have fallen in love with the patient population, the mixture of procedures and clinical care, and the mindset and camaraderie of those who work within the field. What perhaps is most important to me is that fact that OB/GYN’s are often the only physician a young woman will see each year, allowing us to serve as true primary care physicians and to serve our patients well beyond the female reproductive system. Prenatal care might be the first time a woman ever goes to the doctor as an adult, entrusting not only her own health but the health of her unborn child. In this sense, the field of OB/GYN takes on a deeper meaning to those we serve. From the moment my passion for OB/GYN began, so too did the uphill battle. Nine times out of ten, when I explain my inklings on my future specialty, the first words out of the other person’s mouth are negative. “I hear that’s a terrible lifestyle.” “So you’ll be working on holidays for the rest of your life?” “Why don’t you just do dermatology; it pays better.” I consider myself a tough and resilient individual, but these words gradually chip away at my confidence, so much that I tried (with little success) to convince myself that I would be content doing a more “lifestyle-friendly” and better-paid specialty. I spent my first year of medical school shadowing every specialty under the sun, exploring my options. Throughout all of my experiences, no matter how hard I tried to envision myself doing another speciality, it felt as though OB/GYN was choosing me. Nothing sparked more joy than the first time I watched a woman bring new life into the world; nothing sparked such a fire within me as witnessing a teenager confide in her OB/GYN that she was experiencing domestic partner violence. Being a physician entails, at the most basic level, a personal relationship with one’s patients; being an OB/GYN arguably entails the most personal of these relationships, with the most personal and vulnerable aspects of one’s self being shared. Beyond the fact that OB/GYN is considered primary care, there is an even harsher reality that explains why OB/GYN’s are not paid as well as other specialties, particularly surgical subspecialties. What do the fields of OB/GYN, Urology, and Orthopedic Surgery have in common? They all incorporate surgery. But what makes the fields of OB/GYN, Urology, and Orthopedic Surgery different? Urology and Orthopedic Surgery are estimated to earn well over $100,000 and $200,000 more per year, respectively, than OB/GYN. And what is the root of these salary discrepancies? OB/GYN is female-dominated, while Urology and Orthopedic Surgery are male-dominated. The gender pay gap affects even the most well-educated and well-respected individuals in this country. Despite these realities, the words of discouragement I hear from those around me, and my own financial fears, I simply cannot see myself doing anything other than Obstetrics and Gynecology for the rest of my life. In my work as a future physician, I will strive to make a difference in the lives of others and use my talents to serve those in most need. Beyond Women’s Health, I would like to build a career at an academic institution, so that I can help train and mentor the next generation of medical professionals and “pay it forward.” Sharing my knowledge and experience with others has always been paramount to who I am as a person, because I have been fortunate to have had numerous mentors help me get to where I am today. Even now, in the busiest time of my life thus far, it keeps me grounded to share my passion for medicine with others and help them in their own medical education journeys. I would like to thank Mr. Beneschott for his consideration in helping me pursue my dream of becoming a physician, and more so, my dream of becoming an OB/GYN. Although the medical education system is indeed broken, efforts like these help us all move in the right direction.