I sat on my floor, surrounded by boxes in various states of organization and disarray, sifting through a pile of papers. I was moving for my surgical fellowship and, of course, put off packing to the last minute. However, in the middle of the hectic and scattered process, a particular stack of papers caught my eye; I felt the need to pause and go through them. They were old and wrinkled now, but I remember receiving each letter like it was yesterday. I had torn open every envelope with anticipation, excitement, and nerves. One page after the other, all with perfect professional letterhead, only to unveil a crisp white rejection letter. There were twenty-one rejections to be exact, all from medical schools.

My story and path to medicine is not unique. It began when I was 17, telling my dad I wanted to be a doctor over a family pizza dinner like it was no big deal. His response was concise, and not what I expected from a physician himself.

“You don’t want to go to medical school,” he said flatly. His response bewildered me.

“Well, yeah actually I want to be a doctor, don’t I kind of have to go to medical school?” I said with the attitude of a typical 17-year-old. He smiled, went about his business, and offered no explanation.

A few weeks later, my dad offered to arrange a shadowing opportunity with an orthopedic surgeon at his hospital. He drove me to the medical center and dropped me off at 6:30 a.m. sharp to watch a total knee replacement. They sent me to immediately change into scrubs. I had never scrubbed a surgery before. I solemnly stood at the scrub sink, washing my hands, copying every move of the attending surgeon with painstaking detail. A cap, gown and mask felt slightly suffocating the first time.

They told me where to stand, where to put my hands, and anything blue was sterile. I stood silently, watching the incision and as they progressed down to bone. The purpose of the operation was to remove old, porous and faulty bone and replace it with man-made shiny new titanium. Someone shoved the suction into my hand and I used it tentatively. At some point, I was given a piece of epoxy they used to fix the knee replacement hardware in place. As I played with it in my hand, I felt it become exceedingly hot and then harden. “Cool,” I said under my breath.

After a period of time, I realized I wasn’t feeling very well; I felt claustrophobic in the surgical get-up. “No one told me how hard it was going to breath in this thing!” I thought to myself. I couldn’t stand the smell of cautery, or the recirculation of my hot breath under the mask. My knees buckled a little and I leaned on the surgical table. “Woah there,” the attending surgeon said, watching me nearly pass out. “OK, you should go sit down.”

For the rest of the surgery, I was relegated to a stool in the corner. Half pouting for being banished, I watched the rest of the operation as a bystander, but still enthralled by each move.

My dad picked me up at the end of the day. He listened attentively in silence as I yammered about everything I saw that day the whole car ride home. I think I even saw him crack a smile or two.

When I was 21, I was a junior in college and applied to medical school for the first time. I was rejected outright. I did not receive a single interview. “Well, maybe next year,” my dad said. I could tell he didn’t want me to hear the disappointment in his voice.

I went to my college advisor to see what steps I could take the next time I applied. “You should look at the Caribbean,” he said. There were several glaring negatives on my application, one being my grade point average that was perpetually pulled down by a freshman mistake. Working my first quarter of college and thinking I was too smart to regularly attend class was a spectacular combination for near failing pre-calculus math class, a pre-med requirement.

“You’ll never get into a medical school in the United States, and you should really just give up on that plan,” the advisor said matter-of-factly. Caribbean medical schools are recommended for individuals deemed not fit or “smart” enough to attend in the states. This perception is often incorrect, as some of the best doctors I know enrolled in medical schools in tropical locales. But as a college kid in my advisor’s office, it sounded like a death sentence. I looked him straight on, tears in my eyes, and simply said, “You’re wrong.” I walked out of his office, wishing I believed those words as much as I wanted to, with a crumpled-up Kleenex in my hand.

When I was 24 years old, I moved across the country to upstate New York to attend medical school. I received only two interviews the second time I applied, and when I was accepted, I took the opportunity and ran. As I packed for the first of many moves in my medical career, I found my stack of rejections. I briefly sorted through them, then placed them back in the file to keep as a remembrance. I moved 3,000 miles away from my family and friends across the country with elation, and didn’t look back.

At 27 years old, I found general surgery. At first, I was afraid to admit how much I loved it. Afraid what that meant for the rest of my life, what it meant for my hours in the hospital, and what it meant about me as a person. I was captivated by making an incision, fixing blood, guts or both, and leaving nothing but a clean white bandage to show for the work. The chatter surrounding me told me it wasn’t a great specialty, particularly for women. Unless of course, you didn’t want to have a family or a life. My nervous energy persisted until I found a few teachers and mentors at my medical school, and I started to have the slight sensation like I belonged.

Once I made this decision to pursue surgery, I started spending almost all my free time in the operating room with an endocrine surgeon and his chief resident. They took the time to show me how to tie two-handed and one-handed knots. They let me close the skin of each incision. “Take it out, that’s not right,” the chief resident and attending would say, over and over. They made me redo every stitch they didn’t like, but they let me sew.

When I was 28, I started my general surgery residency. It was a terrifying and amazing experience, all at once. I loved every part of it and finally felt at home. The years went by quickly, and while I flirted with several specialties, I found what I thought was my one true love in critical care and trauma. I had a path, and I was on it. For the first time, I felt there was no ambiguity about which direction I would go. It was comforting and reassuring, a feeling I was unaccustomed to in my path to surgical training. I completed a research year and started my fourth year of general surgery residency with all the boxes checked to apply for a surgical critical care fellowship. For once, things seemed easy. However, no sooner was I comfortable, when the fight started anew.

I was 33 years old when I found pediatric surgery. Nine hours into a tumor resection for a 10-year-old boy, we were finally closing the abdomen. A friend of mine was a junior resident interested in pediatric surgery and came in the operating room to see what we were up to. He asked me about my rotation and I spouted off about patients and their families, the amazing operations, and how fun it was to round in the morning. The praise continued until he stopped me and said, “You know, you’re never going to get to do this again.”

His words washed over me, and as their meaning sunk in, I took a sharp breath. It felt as though I had the wind knocked out of me and my eyes watered up. This was the last time I was ever going to get to take care of children and do this job. I swallowed hard, bit my tongue, and tried to push the idea out of my head. After all, I had a path and a plan already, it was too late to change. But I couldn’t shake the feeling I was doing the wrong thing.

The next two weeks were a blur. I was having a professional identity crisis. I talked to my attendings, mentors and program director. I argued in my own head constantly.

“I am a trauma surgeon, I can’t do pediatric surgery.”

“Even if I wanted to, the specialty is so competitive.”

“It’s way too late.”

External voices had opinions too. I was told it was too late by my peers. I was told it was too risky by my advisors.

I finally ended up in the office of the Chair of Surgery, who was a pediatric surgeon herself. She knew why I was there, as the grape vine is small in the surgical word.

“Can I even do this?” I said.

“Well … it’s fucking crazy, but yes you can do it.” she replied.

It was one of the first times during my path in training that I heard yes to a question, and I am grateful for the response to this day.

I am now 36 years old. I am one month from finally finishing all of my training and being able to call myself a pediatric surgeon. It is a goal that I literally spent my entire life pursuing. And without a doubt, I have been told no on this path more than yes.

My story is not special. My story is not much different than anyone else’s. People slip through the cracks or don’t believe in their dreams every day. Without the people in my life who believed in me, I might very well be in the same boat. I am thankful for my father, for sending me to shadow when I was 17. I am thankful for my medical school mentors, who let me sew. I am thankful for those teachers in residency, that told me I could do whatever I wanted. I am thankful for those individuals who said yes.

And, I am thankful for those 21 rejection letters. Because without them, I would never know what it is like to fight for a dream. So, for now, I will keep them in my filing cabinet, shuffle through them from time to time, and remember the fight.

Caitlin Smith is a surgery resident who blogs at Education of a Knife.

Image credit: Shutterstock.com