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Home: The Toast

I don’t think my anxiety would have spun out of control quite as quickly had my family been more conscientious about their health. Or, to be more accurate, if my father had actually gone to the doctor more than once in the past decade.

He’s young, for a father of a 25-year-old (only 52), but his family history is riddled with cancer and heart disease, and his nightly wine consumption doesn’t exactly do his liver any favors. And so, I worried.

I would have been concerned regardless of my career, but last spring I was a second-year medical student, deep in the thick of Step 1 season. Step 1, the first of three United States Medical Licensing Exams, is typically taken by second-year medical students in the late spring and early summer. Not only is it intimidating in the sense that it matters for your eventual licensing requirements, but it’s used by residency directors like a medical school SAT: score well on Step, and you have a fighting chance at the more competitive specialties (dermatology, plastic surgery, ENT) or a spot at a prestigious hospital; tank it, and you are looking at family medicine or psychiatry in rural Alabama (my own personal nightmare).

And so, last January, our dean of students sat my class down for a serious talk about our study schedules, instilling in us a sense of doom about our futures should we not spend the next six months poring over review books and banks of practice questions, memorizing every possible clinical scenario and the mechanisms of every known disease process or pharmaceutical (all of this in addition to our regular schedule of already-rigorous classes).

Most of us left the meeting and walked straight to a bar.

Two weeks later, my classmates once again filled the lecture hall, this time for a half-day seminar given by the parents of a former student, who, despite a promising future and a flawless transcript, had jumped off a building downtown into the traffic below. His depression had gone unnoticed and undiagnosed; he died just a few months before he was to begin interviewing for residency positions.

We sat there, just as quiet and attentive as we would have been in a histology lecture, watching as picture after picture of their son slid by, all of them immediately recognizable to us: one of him grinning in his new short white coat, one clearly taken by a classmate as he dozed in a library cubicle, one of him on the beach with friends, gleefully racing into the surf.

Our school, like many other medical schools, had something of a suicide problem, with one or two cases every few years, a startling number for so small an institution. It’s not news that depression and anxiety are common in medical students: a quarter of medical students report suffering from one or both of them, and the symptoms typically worsen in the second year of schooling, coinciding neatly with the beginning of Step 1 preparation.

The administrators were sympathetic, almost desperate in their attempts to convince us that they would love to help us, that they cared about nothing more than our mental stability, that nothing detrimental to our careers would ever happen as a consequence of admitting your mind wasn’t quite capable of effectively compartmentalizing the hopelessness that stole over you when you finally realized there were infinitely more ways for the human body to fail than there were methods to repair it.

They admitted there was a stigma, that there was indeed a history of mistrust of physicians who sought treatment for mental health issues, but they promised it would be different for us.

I believed them, but I still didn’t tell anyone. I adhered to my schedule, taking practice question after practice question, neatly annotating my review book with little details from the questions I missed. That’s when I first noticed how neatly my father fit into the question stems: “A 52-year-old male with no primary care physician comes into the clinic with complaints of chest pain on exertion (or anemia from an undiagnosed colon tumor or unexplained abdominal swelling from liver failure or any other presenting symptom from the slew of insidious, ultimately fatal diseases).”

I sent screenshot after screenshot of these questions to my dad, ostensibly as a joke about how lax he was about taking care of himself, but secretly hoping to frighten him into getting a check-up. And while he would take one look at them and delete the texts, completely unconcerned that tendrils of mutated cells were slipping into the walls of his organs, I would lie awake, attempting to reconcile myself to a future without him.

A few months before, I had moved in with my boyfriend, a fellow medical student, in an attempt to maximize our togetherness during what we knew would be a nightmarish semester. Frequently, I would poke him awake, sticking my index finger deep in the soft space between his ribs, then asking him to tell me that my parents weren’t going to die soon.

He never once complained, and he would always hold me securely afterward, during the inevitable sobbing that commenced after I confessed that I couldn’t imagine a world without them.

Unlike anyone else who was poked awake on an almost-nightly basis by an inconsolable ball of anxiety, he didn’t recommend I seek help. We were both aware that my behavior neatly lined up with a diagnosis of an anxiety disorder, but I couldn’t afford to potentially blow months of studying with any mind-altering medications. My future, the career I had devoted the vast majority of my waking hours to for the past six years, depended on my successful completion of Step 1, and I wasn’t about to endure weeks of fuzzy headedness while my dose of Paxil was appropriately calibrated.

While my boyfriend endured his interrupted sleep without objection, I have never been one to tolerate sleep disturbances, and so I turned to an alternative treatment for my anxiety: romance novels.

Long a staple of my reading diet, romance novels came into my life in middle school, as they were the only reading material in my grandmother’s house. Initially skeptical, I soon recognized the similarities between the glamorous and deeply troubled heroines of my grandmother’s bodice rippers and the equally beautiful and intoxicating Wakefield twins, stars of my beloved Sweet Valley High novels. At the time (and for years to follow), boys were not especially concerned with my weekend plans, so I spent many a peaceful night curled under an afghan in my grandfather’s worn recliner, reading my way through Nora Roberts.

Romance novels became my comfort food, the books I read when my mind was too fragile or exhausted to contemplate heavier works, and so it was natural that I turned to them when my defenses started to fail me. I downloaded a few new Regencies onto my Kindle, and started to read them every night before bed, in an attempt to stave off my intrusive obsessions regarding my parents’ eventual demise. It worked, at first, and I finally started falling asleep thinking not of the state of my father’s liver, but instead how nice it was to fall asleep next to the person I loved.

But they were too easy to blaze through, and my student loans were not nearly extensive enough to cover an e-book a night reading habit. I tried rereading Jane Austen, but she just wasn’t prolific enough to satisfy my voracious appetites.

And then, like manna from heaven, Georgette Heyer fell into my life (as suggested by Amazon, inspired by my browsing history). Inspired by the glowing, almost worshipful reviews, I cautiously placed an order for Frederica, one of her most popular works. Three days later, I finally put it down, much to the relief of my boyfriend, who was not so in love with me that he was able to feign enjoyment of the many passages I had quoted to him. I immediately placed an order for five more of her books, throwing my budget out the window, but unable to resist the siren call of Georgette.

Her books occupied the space between Jane Austen and my collection of Judith McNaught and Lisa Klepas novels: just long enough to take two or three nights of pre-bedtime reading to finish. Even better, she was tremendously prolific, with over thirty published romances.  I allowed myself two per week, strictly reserving them for the hour before I fell asleep, only making exceptions for the days I felt entirely overwhelmed or adrift. My Georgette schedule was as meticulous as my review schedule, and I pored over the Amazon reviews of her books as if they held the clue to my sanity.

The transition from the character-driven but lightly plotted Regencies I had previously favored to the dense plots employed by Heyer initially frustrated me, likely exacerbated by the fact that I preceded my evening reads with tedious rundowns of my microbiology flash cards. But as I grew accustomed to deciphering her character’s doublespeak, I began to relish the rapid-fire dialogue that revealed major plot twists despite centering entirely on mundanities like the transit time to France.

While Heyer’s novels were romances in the sense that the protagonists eventually hooked up (off-page, obviously), they rarely depicted a simple courtship; instead, through a series of complicated developments, the heroes fell in love alongside the central plot and the inattentive reader would be hard-pressed to pinpoint the genesis of the relationship. Tracking the affair required a rapt attention to detail that banished the lingering anxieties of the day that idled in the back of my mind; with Heyer, I could only read, not fret.

Still, I couldn’t really explain why I fell so completely under the spell of Heyer’s books. Unlike most authors who encourage immediate obsessions with their books by crafting well-developed new worlds or frustratingly inscrutable thrillers (I still skim the ending of every Pretty Little Liars book I see, even though I have yet to read past the third book of the series), Heyer writes straightforward comedic romance novels. Even more inexplicable was my complete satisfaction with her smut-free endings: everyone knows otherwise-perfect couples who failed to make it work due to fatal incompatibilities in the bedroom, and, ever the discerning reader, I refused to take the sexual satisfaction of the protagonists for granted. Yet, when I closed Cotillion for the final time, I was actually grinning, as if a scene detailing the chaste removal of a bonnet and a simple kiss was worth such giddiness.

Like Jane Austen before her (and many a romance novelist after), Heyer never delves too deeply into the seamier aspects of life: no one ever contracts any loathsome social diseases, and the maternal mortality rate of that era only creates a more permissive environment for her motherless yet irrepressible heroines. Even on the rare occasion that illness or infirmity invades her plots, it’s generally either an unfortunate but ultimately benign ailment like gout, or a rare childhood malady utilized in advancement of the plot, as seen in Venetia. Venetia’s horridly precocious younger brother, Aubrey, suffers from a troublesome hip disorder, resulting in a significant limp and limited physical mobility, yet his condition served more as a litmus test for Venetia’s more unsuitable callers than a source of tragedy in their lives.

Before that spring, I loathed such falsely rosy depictions of life in the 18th century, but now I delighted in them. I didn’t even punish myself by attempting to diagnose Aubrey or sort out his prognosis. Instead, I relished that all of these young women, many of whom had already been touched by tragedy, were able to exist so confidently in such an uncertain time.

Eventually, I hoped my father would finally grow tired of deleting yet another set of CDC cancer-screening recommendations from his inbox, and he would return from the gastroenterologist’s with a lovely set of photos depicting the malignancy-free state of his digestive organs, but none of Heyer’s women would ever have that luxury. They existed in a constant state of upheaval, made even more hazardous by the lack of control they exercised over their own lives, and yet even they weren’t spending the better part of an hour each day performing mental gymnastics to cope with their fears.

I can’t say that I managed to conquer my anxiety with Georgette Heyer, because crippling anxiety doesn’t just fade away with a rigorous diet of romance novels, but coping was easier with Georgette. The worlds she developed, the lovely women she wrote, reminded me that existing wasn’t just an inevitable and unwinnable fight to escape death. Studying for Step 1, and medical school in general, framed life as a series of traumas or sicknesses, and for so long, my thoughts were consumed by the potential for those in my own life. Heyer’s books reminded me that the vast majority of our days were not spent on sickbeds, but rather sparring with siblings or conspiring with friends, and maybe even finding the one person that slows your whirling mind.

After I found Georgette, my boyfriend started sleeping through the night again, and my frantic texts to my father petered out, although I still had to be talked out of the occasional anxiety spiral. The night before I took Step 1, I stayed in an anonymous, bland hotel favored by commuters, just a few exits up the road from NASA. Instead of running through a final set of practice questions, I cracked open a fresh Georgette Heyer, and read until I fell asleep. I awoke refreshed, ready to take the test that had dominated my life for so many months, and when I finally walked out of the door of the testing center, nine hours later, I thought of nothing else but finishing the story I had begun the night before.

Works Referenced:

Georgette Heyer The Black Moth: A Romance of the XVIIIth Century (Indiebound | Amazon)
Georgette Heyer, Cotillion (Indiebound | Amazon)
Georgette Heyer, Frederica (Indiebound | Amazon)
Georgette Heyer, The Great Roxhythe (Indiebound | Amazon)
Georgette Heyer, The Unknown Ajax (Indiebound | Amazon)

A Medical Student will graduate medical school this spring, and plans to pursue rural primary care. She lives in Texas with her dog and her husband.

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