Medical Students don't often talk about failure.

They talk about the idea of failing, the fear of failure or, in hushed, disdainful tones at the front of lecture theatres, about someone who didn't pass. Some medical students have never flunked anything in their lives. They are wholly unfamiliar with the bitter taste, the anguished self-reflection or the smell of raw failure.

Earlier this year, I failed a rotation.

Shock.
I eagerly looked up my marks and was hit by a bus. I hadn't just failed one component, I'd failed a bunch. I felt sick to the stomach. I wanted to call someone; to talk to someone, but I was on rural and thoroughly isolated. Not all bad, I thought, I can wallow in shame and self doubt for a few days. Which I did.

I sat in the house at SQuIRT in shock. I went over each exam in my head. I clearly remembered each patient, what they looked like, their names, their differentials.

Analysis.
I recalled the facts of the long case; I'd presented it pretty weakly, and the examiners hammered me for questions. Of this I was least confident, I mean, I knew the patient had Congestive Heart failure, but, well, I'd made a hash of the presentation.

I knew I'd made a Zebra diagnosis for one patient which was wrong; I'd had the actual diagnosis in my list of differentials. The presentation was a deforming polyarthropathy of the hands.

The last chap had a pleural effusion. I skipped vocal resonance, but asked for a CXR when I got heard decreased breath sounds, and noted the opacity's menisceal appearance in the appropriate hemithorax.

Fear.
I hadn't felt particularly confident at the time; they were clinical exams with Professors and I was intimidated and nervous. Really nervous. Frankly, I thought that I'd done poorly, but not this poorly. And not in all of the exams. I could recall several exams I'd sat in the past where I'd had that 'just enough to scrape through' feeling, and I'd had that same feeling afterwards.

I'd never failed anything before. I felt empty. And dumb. And scared. My underlying sense of academic invincibility had been smashed over my head like sugar-glass bottle in a kung-fu movie. Dazed. Scared.

Frustration.
I called my parents and vented frustration; I was still too proud to admit that I'd made a hash of things. I didn't want to do eight more weeks! I wanted to graduate on time, with my mates. I sure as hell didn't want to go through the 'special application process' for intern jobs, and start the year late. I am not the person who fails! I don't fail.

Self doubt.
But I had. And not in a small way. Self-doubt nibbled at my toes, then ankles and wrapped around my knees. I felt like medicine could be tackle me to the ground at any second. I was, of course, still seeing patients out at SQuIRT. I started asking basic questions that I knew the answer to. I wanted to know that I had some clinical acumen. Late at night I'd stare at the roof, thinking about becoming a doctor. Was I smart enough? Did I have the skills?

Determination.
About 2am, something clicked. I am smart enough. I do have the skills. Of course they're not perfect. This is a learning curve. I need to know more. I will learn more. I thought long and hard about what I'd done wrong, and what I'd do differently. I had a bloody long list. I will be a doctor, and I will be a bloody good one. I will learn from this setback and retake my medicine.

Frustration, again.
The next morning, I rang my clinical school, and arranged to meet with the Prof. I wanted feedback so I could see exactly where I'd gone wrong. I had some ideas, but I needed confirmation and some direction. He was honest, brutally honest. We discussed both my clinical and professional shortcomings. He reassured me that I'd be able to stay at the Coast when I resat the rotation. We talked through some styles of clinical thinking, and he reassured me that my rationale was sound, that I was safe. There was still a nagging, frustrating feeling in the back of my brain. It wouldn't go away. I wanted to have passed, and couldn't change it. Grrrr!

Relief.
Back out Rural, I bided my time, I had a list of deficiencies in my knowledge that I felt were too glaring to be ignored. I corrected and ameliorated the obvious holes I'd established, and focused on the exam block. At the start of the subsequent rotation, I got an email from the SOM. They'd done an audit, and they'd goofed. Turned out I'd passed everything but the long case, barely. I didn't have to repeat the rotation, provided I passed a Supplementary exam. It was in six weeks' time. I felt back in the game, barely. I wasn't drowning, but I felt a swimmable ten kilometres from shore.

Determination, again.
I wrote down my long list and began to study; I wanted a structured approach. I put together a plan. I had a timetable. I planned to see patients. I would join in remedial classes. I asked for help from previous clinical mentors. I read and read. I consolidated. I did a practice exam with the Prof. He gave me a solid pass, with some pointers and tips. I was studying for two rotations at once, and by jove, I was going to bust my chops to past that supp'. I'd been given a chance, and with knowledge, practice and determination, I'd take it.

Self doubt, again.
I sat the exam. It went better than the first time. I was less intimidated. I was methodical. Two aspects in particular I was unhappy with; one of which was time management. I fluffed away my post-interview planning time, and my structure suffered. After the exam was finished, the markers casually requested I attend for feedback a few days later. I blanched. I wasn't sure what to think. Had I completely blown it? I'd constructed a solid list of differentials, and was able to discuss the key pathologies at play. I felt like I knew my stuff, that I had a well-rounded plan for the patient and a good grasp of their situation. Oh no. This was starting to feel bad. I had a sleepless night. Or two. Self-doubt was back. I considered that I might have failed. Seriously considered.

Relief, of a sort.
I showed up for the feedback session prepared to discuss, and learn. I'd rationalised that if I had to re-sit the entire rotation, I'd lost only pride, and gained the chance to learn again. I passed.

The relief wasn't that total, complete weight-off-shoulders feeling that usually comes with passing "final" exams. It was partial; I had achieved the mark, I'd learned much about myself in the process. This rotation wasn't a final anything; it was a checkpoint. Amongst else, I learned to be more systematic and logical. The lessons are still raw.

I still get whiffs of the smell of failure. I'm not intimate with the scent, and nor do I want to be. Until a few weeks ago, I couldn't have told you what it was.