I applied to medical school twice. In retrospect, I was unsuccessful the first time for a few reasons: my timing was terrible, I had too much humility about my achievements, and I didn’t ask for enough opinions about my application from people who were rooting for me. My trauma was also too raw and recent to write in a way for strangers to understand.

After taking a few years to focus on research, I applied a second time. I didn’t take additional classes, so my GPA hadn’t changed, and my MCAT was about to expire. However, the second application felt completely different since my first application. The lawsuit with my trauma at its epicenter was finally settled. Traumatic night terrors were no longer a simple letter or phone call away from being sparked. I also had a much better support system of friends, mentors and a loving partner. I reached a point of moderate closure, and although the long-term health consequences never went away, my life was simply more comfortable.

Instead of marathon-writing for my application in the evenings after work like I had during my first attempt, I accrued vacation days to strategically take a week off. I sometimes spent an entire day simply reflecting on what I wanted to write. I gently coaxed out streams of consciousness without interruption and soon had a draft. When I asked my partner to scan it for flow and typos, I got a response that I didn’t expect: “Wow, I didn’t know you went through all of that at once. You are a total badass!”

I appreciated the sentiment, but the mystified tone caught me off guard. I hadn’t interpreted the events in a tidy chronological order before. I double-checked dates and confirmed: I definitely went through hell and back a few times over in a handful of years, not to mention everything that happened before then. 

Briefly, I worried that my personal essay would come across as a sob story instead of the story of triumph that I was living. I didn’t want my personal statement to become a list of sad reasons why I deserved an opportunity or pity. It was supposed to be a presentation of obstacles I overcame, show that I was tough as nails, and declare that I was ready to become a physician-scientist.

—

I have long known that stigma exists in medicine at every level, especially around mental health. From the psychological tolls paid in medical school to the historically impossible standards required to receive USMLE Step 1 accommodations to state medical board licensure consistently violating the Americans with Disabilities Act (ADA), the stigma runs undeniably deep. Like some warped game of trauma Jenga, I considered how each aspect could be understood or potentially misinterpreted by a field that widely disparages and even makes students feel at fault for mental health disorders. 

My personal statement detailed one of the worst days of my life and began in the emergency room. Instead of describing specific diagnoses, I described what the experience felt like, looked like, and what I was reflecting on in that moment. My first paragraph didn’t report what happened; instead, it described waves of thoughts I had while waiting for imaging results. Slowly I revealed the context, the injury and the implications. I used 118 words to vividly describe four words I never outright said: post-traumatic stress disorder.

In closing, I described my daily life in contrast, but also alongside, those challenging events. Though much of my story was obviously not cheery, I made sure my tenacity shined through in a clear way. I highlighted my grit: I knew how to take care of myself and I could fight like hell. I also made a point that I never reverted back to my old normal — and probably never will.

Because I focused on specific events, my essay barely scratched the surface about my childhood adversities. For that, I used the brief disadvantaged status essay; this is an optional submission in the primary application that lets medical schools know they should consider social, economic or educational factors that put you at a disadvantage compared to other applicants. There is not enough character space allocated for this essay by any means, but admissions committees don’t necessarily need narratives about which family member went to jail or why. They mostly want to know how your challenges have impeded your education and journey to medicine. So, I used this mini-essay to reiterate the fact that in the context of my background and trauma, my not-so-competitive average MCAT was something that I celebrated as a victory.

As I worked through my primary and secondary applications, it felt like I was repeatedly having to poke at old wounds for many months without a break. I found myself often exhausted and struggling to balance my busy pre-med life with sporadically reliving trauma. I learned that no matter how far along you are in your recovery or how far away your trauma seems, the process of writing and rewriting about it can affect you in ways you may not expect over the year-long application cycle. You will constantly consider and reconsider what should go in your essays and how to say things carefully. And when you write about traumatic experiences, you might not seek as much input about your writing as you would with any other essay because it feels so personal. Based on what I learned through my application cycles, interviews and successful matriculation as an MD-PhD student, I offer a few guidelines here to help safeguard your well-being during this strange and challenging process.

WHILE YOU ARE WRITING

Take care of yourself by doing the following:

• Ask yourself: is re-reading this over and over encroaching on your well-being? Plan frequent activities to refresh and recenter yourself. Tap into your support system while you still have the document open in front of you. Let them be part of it. Consider making a preemptive appointment with a counselor or psychiatrist if they have helped you before.
• Give yourself space. You may be re-opening these wounds for drawn-out periods of time while completing secondary applications and going to interviews. Be aware of how this impacts your needs differently than when you are not constantly revisiting your trauma. You may be more socially burnt-out, easily irritable or experience manifestations that you thought were long gone.
• Consider your tone: write the experience, not the event. Don’t focus on fine details. After all, two people can endure the same event, but the way they cope is extremely different. Medical schools want to know about your response to your experience and how it relates to your call to medicine. Be careful not to dissociate and write from a distance like a news reporter (this is something I caught myself doing a lot).
• Remember: medicine truly needs you to be part of it. It’s not a question of whether you are good enough to get in, but whether there is enough space for you to squeeze through a crowded door. The majority of physicians come from privileged backgrounds, which has been shown clearly by medical school matriculation data for at least 30 years. But others simply do not have (and likely will never have) the invaluable experiences that enable you to better understand your patients. Both physicians and patients benefit from your presence in medicine.
• Do you really want to say that? Let your essays air out before you submit them. No matter how tough you are, this process will whittle you down. I wrote some terrible essays for relatively benign prompts because I hadn’t worked through leftover emotion from another essay. While writing about why I had a ‘W’ on my transcript due to a crappy professor, I noticed my tone was unprofessional and downright scary. I was only able to recognize this after letting the response sit and coming back to it a few days later.
• Always convert your essays to a .pdf or some other visually distinct form to read one last time before you submit. This is an easy way to pick up mistakes or mismatched tone that you might not otherwise notice. 
• If possible, ask people for their perspective. I posted on Facebook asking if people would be willing to proofread. My readers were old co-workers, classmates, exes, and people who had only a vague idea of what I went through. This is difficult if you are not open about your trauma, but remember that strangers will be the ones ultimately reading your personal statement. It is imperative that people who are not close to you share their interpretation. If you are deeply uncomfortable revealing your story to acquaintances, consider how you might write it differently so that you do not feel so exposed. Ask yourself —  what is it that makes you feel that way? Think about whether the thought of some aspects coming up in an interview makes you uncomfortable. It is easy to fling things into the void online, but ultimately strangers will be reading your story and asking you about it. Alternatively, you can ask for feedback in pre-medical groups to get perspectives from other applicants and current medical students.

INTERVIEWS

There are two jarring directions for an interview to go if your essays contain a traumatic event:

1. You poor, poor thing.
2. It’s great that you’re all better now.

Each one hits differently. The first implies that your interview may be a pity party and could take valuable time away from talking about your accomplishments. The second puts you in the awkward position of telling your interviewer that they are wrong and having to correct them. Both are tricky to navigate and caught me off guard.

For the first, I wielded my sense of humor while steering the conversation by nodding that yes, my life has sucked, “but I sure did a lot of cool research, huh?” For the second, I gently corrected them with, “While I wish that were true…,” careful not to over-share or diagnose myself on the spot but remaining adamant that they understood my trauma was something that was not over with but lived with, and how that made me a better student and future physician.

I made mistakes during my first application cycle that gave me the second chance to start medical school with greater peace. Even medical students without trauma in their backgrounds emerge from their first two years feeling mentally taxed by tremendous stress and pressure. As survivors of trauma, we can sometimes be haunted by conditions that are worsened or even sparked by such an enormous new burden of stress. Ensure you start off on the right foot by prioritizing your mental health earlier, starting with the application process. And remember: your goal in writing about trauma is not to prove anything. Rather, it is a chance to reflect on what you have been through and what that means on your journey to medicine.

Image credit: journals (CC BY-NC 2.0) by Ganamex

Britt D.K. Gratreak (1 Posts)

Contributing Writer

University of Arizona College of Medicine - Tucson

Brittany D.K. Gratreak is a second year MD/PhD student at the University of Arizona College of Medicine - Tucson. She began college at Portland Community College, then graduated from Portland State University in 2016 with a Bachelor of Science in biology. She is an active leader in women's medical professional groups and dedicated to creating mentorship opportunities for fellow first-generation and low income (FGLI) premedical students. In her spare time, she enjoys cycling, strategy games, and creating art. After graduating medical school, Britt wants to revolutionize the care of patients with traumatic brain injury through neurology and neuroscience.