It should fall under the differential diagnosis of “feeling of impending doom.” When the time comes to request a letter of recommendation from my clerkship preceptor, I feel the old phobia overtake me. Instead of being my regular, happy-go-lucky, “the-future-will-sort-itself-out” self, I turn into a blathering, inarticulate, bumbling ball of incomposure. Like a pony without a trick, I am nearly incontinent.
“Dr. X,” — deep breath — “I was wondering if, ahh, if you would be willing and comfortable, umm, both or neither, to write me a, ahh, letter of reference” — another breath — “for my residency application.”
I ask with such a grave seriousness that he looks as though I am requesting his kidney. Thank heavens I manage to spit out the “letter of reference” part before he has time to come up with a solitary-organ excuse:
“Farrah, I only have one kidney, but I would write a letter.”
My prelude is contorted and discombobulated, but I persevere. There must be more agreeable ways to shorten one's life expectancy than this! I should stick to supersizing my fries.
Indeed, I might as well say, “Guess what? Your undergraduate student is a turnip. Ipso facto, would you like to support a turnip for a residency program?” I cringe as I put my hand on my forehead and wait to overanalyze the initial response. Will it be “Yes,” “Yes, my pleasure” or “Yes, I would have no trouble doing that”? What level on the scale of enthusiasm? Will there be a flicker of hesitation? Even worse, will it be “No”?
How would I make a joke out of that?
“No Christmas card for you.”
The burden of all these reference letters, the currency of promotion from undergraduate student to candidate for dean, falls squarely on the busy physician, the good communicator, the committed teacher ... the quintessential doctor. Some accept the task gracefully. Others pass the buck. Some pay attention. Others don't know your name. The willingness to contribute meaningfully in this fashion often goes unrecognized, and sharply contrasts the attitude based in the result-driven milieu of the rest of my education.
Through letters to various scholarship and bursary committees, referees help finance what would otherwise be a prohibitively expensive education for many medical students today. They also play a large part in supporting students who will join tomorrow's ranks of medical professionals, and, more often than not, their reply is “Yes, my pleasure” and (my friends and) I have hyperventilated without just cause. Reference letters aside though, there are academics and professionals whom we have myriad reasons to admire and emulate: not simply because of their accomplishments but, more importantly, the dedication and humanity that guide them.
I extend a tremulous, diaphoretic hand in gratitude.