Well, it’s been an entire eight months since my last away rotation and the attendant crippling anxiety brought on by the realization that everyone else is smarter than you, so we’re overdue.

The fourth year of medical school is especially strange with respect to my favorite syndrome.* After the end of away rotations and the submission of your residency application, interview offers start rolling in. As a medical student who by definition has spent the last 40 months getting emotionally kickboxed by people higher up on the totem pole (which is everyone), the interviews come as a wonderful respite.

For example, the interviewing school repeatedly praises your worth as a human being and potential fit for their residency program. They feed you lunch and sometimes dinner and sometimes they have great snacks. They offer you pens. They offer to let you sit in the helicopter and take selfies. They offer complimentary alcoholic beverages. It is a weird juxtaposition, mixing Stockholm syndrome with the second-grade nerd and bully victim making his first friend.

*If you thought, “hey, what does Turner syndrome have to do with this,” I assure you that IT IS NOT MY FAVORITE SYNDROME AND I NEVER WANT TO HEAR THE PHRASE ‘WEBBED NECK AND WIDELY SPACED NIPPLES” AGAIN. My favorite syndrome is Impostor Syndrome. You asshole.

This image torments me.

In between interviews, no one from the medical school really bothers you. Mostly you are left alone, with a striking absence of being s**t on. And then in March you match, and even if you have more rotations to complete you don’t care, and then you get lots of nice emails and paperwork from your future residency program, and then you graduate.

At the end of all that, you’re feeling pretty good about yourself. After all, finishing medical school is a huge accomplishment! It took a lot of hard work, a crap ton of money, and the skin of a rhinoceros to make it this far. You’ve been pooped on, vomited on, screamed at, cried to, slept on, and probably worse. You’ve also done most of those things to someone else, hopefully aside from the first two. You should be proud of how smart and accomplish—

What’s that? Residency starts in less than two weeks?

I literally cannot believe this statement. As I wrote last week, I am not smart enough or mature enough or prepared enough to be a doctor. I once thought it was a good idea to chug a Bud Light through a funnel and a garden hose. I am not qualified to be entrusted with a dog – in fact, I am not entrusted with a dog. The Rabbit Vengeance Machine is cared for by the far more responsible Parental Units.

Anyway. I just signed a lease on an apartment in my new city and am now committed to this whole residency thing, since the security deposit basically precludes my Plan B of moving to Costa Rica, opening a B&B, and spending my days staring at the water like Tom Hanks in Castaway.

(That was entirely an excuse to re-introduce my favorite volleyball, Wilson)

I am instead confronted with the very real prospect of having to convince an entirely new group of people – a handful of co-interns and a large number of co-residents, not to mention faculty supervisors and patients – that I actually do know what I am doing.

Of course, this was never true in medical school, and it’s not true now. But as our current politics demonstrates, it’s not really what you know or do, but what people think you know or do. Perception is reality in medicine, too.

Lest you think I am exaggerating my incompetence, I would simply remind you that the last time many of classmates touched a patient, we had a different president.

Actually, that merits an interesting aside: as part of the neuro exam, it’s common to ask patients, “Who’s the president?” as part of the initial “alert and oriented” screening test. You can tell a lot about someone’s politics based on how they answer that question. My favorite two:

• A 89 year old little old lady with a urinary tract infection who was the sweetest person I ever met… until she responded to my presidential query by spitting out, “Barack HUSSEIN O-BAMA,” and rolling her eyes. It was as if I asked her to identify the murderer of her child.
• A 44 year old man in the intensive care unit who, post-2016 election, looked heavenward and said, “please don’t make me answer that question. Cheetos cannot be presidents.”

Anyway. At one point, I could list you the differential diagnosis for abdominal pain, divided by quadrant. I could expound upon the various antibiotics that treated strep, staph, and their resistant varieties. I could recommend a workup for a patient with new shortness of breath.

(Okay, I could never do all of those at the same time, but whatever.)

Now, I’m lucky if I can just avoid asking any really stupid questions in the exam room, such as “Do you think Isiah Thomas showed courage or stupidity in trying to block LeBron James in Game 1?” or “Would you say your diarrhea is ‘copious’ or just ‘frequent’?”

In the words of Seventh Grade Nate, “I am in the wrong math class.”

I am, as I always have been, an Imposter.