Pain in the Neck

“Pain is inevitable. Suffering is optional”-Haruki Murakami

Welcome Home

Upon returning to the US from a Nepali hospital, my need for physical recovery dovetailed nicely with a need to buckle down for the most difficult portion of my PhD studies: the qualifying exam. The, qualifying exam takes place prior to completion of the second year of graduate school. It determines if you get to continue to pursue your doctoral degree or take a hike (in my case probably literally). First you select a committee of professors with expertise in your field (mine is neuroscience) and you must present a formal research proposal unrelated to your area of study. Initially, this means a written 8-page national research service award (NRSA) style grant submitted to to the committee for review. Following the receipt of this document, the committee proceeds to prod and poke at any logical misstep or incomplete understanding you have on the material. At the committee meeting, they then expose your weaknesses or failures in understanding via a cross between Socratic method of cross-examination during your presentation.

I have heard this process likened to sharks sniffing for blood in the water prior to a feeding frenzy. A close friend of mine put it well when he said, “it’s not a test for intelligence, it’s a punishment for arrogance”. The worst thing you can do is push forward arguing your grant proposal when caught in a logical misstep, you need to admit when you don’t know something. Even if you write a perfect proposal, your committee will find something dig into that point for 1-3 hours until you tap out. There is no score or grade, instead there is a vote of either pass, fail, or conditional pass. Conditional passes often involve a revision of the written material or possibly an additional course to fill in lapses in knowledge, and a fail means you should leave the program.

Knowing this, many students opt to stack their committees with friendly or easygoing professors or clinicians who they know will not give them a hard of a time, so that they may progress unfettered into the dissertation research phase. That is not my style, I opted to challenge myself. I selected a committee that I knew would scrutinize me heavily. If was to obtain a PhD, I wanted to earn it in the eyes of scientists who were highly skeptical and discerning and who I have great respect for. Looking back, this seems unnecessary but perhaps my recent failures in Nepal left me wanting yet again to prove myself in some medium that I was not an impostor and another harrowing rite of passage would prove that I belonged.

Study Up

Prior to my exam, I became aware that I had herniated discs in my cervical vertebrae compressing nerves that ran down my neck. It felt like there was a golf ball sized knot that would appear in my right shoulder and generate tension and pain strong enough that I could not turn my head to the right. Nor could I walk, run, or at times sleep. I first experienced this awful monstrous knot of tension running from the back of my skull down my trapezius muscles when I was 18 or 19. Not knowing at the time how severe the issue was, I opted for every possible naturopathic intervention strategy. Chiropractic treatments combined with cupping, acupuncture, Rolfing, deep tissue massage, daily Yoga, inversion tables, sauna, ice, and pressure guided cervical traction would keep the pain reduced but didn’t stop the flare ups. As the pain increased, I opted for steroid hormone injections in the disc which didn’t do anything. Eventually, I reached a state where I adopted chronic pain as my baseline and tried to push through it. By the time I had gone to Nepal to climb big mountains, I was in the eye of the storm with minimal pain, but also without having resolved the issue at all. Even by the end of the trip and after my return to the US, I was not inhibited by the pain as I had become accustomed to the goblin living between my neck, ribs, and scapula.

Prognosis

My 2-3-hour exam began first with me being sent immediately into the hallway to wait alone. I felt like wearing an invisible dunce cap as I awkwardly stood in the hall in dress clothes. Other students and postdocs walked past exchanging knowing looks and offering good luck wishes. The 5 professors on my committee began to talk about me and my previously submitted proposal for 20min or so. Mostly, I just closed my eyes and compulsively rolled my shoulders down back while tucking my chin to mitigate the pain. I hoped that the muscle relaxers would kick in by the time I had to stand up in front of the committee and present.

When I was beckoned back into the room, I began to present but was interrupted every few minutes with intellectual jabs. I tried to parry the best I could, and answer questions where I knew the answers but after an hour or so things were taking a downward turn. It was clear that I had limited knowledge in the molecular biology, and real-world limitations of the methods that I had written about in my proposal were something I did not fully understand. These experimental details are not written in textbooks. They are things you learn from experience or methods-based journals. I had limited experience with molecular biology only had completed a few techniques having recently joined the lab and the committee knew it. Unfortunately, the rules of the exam at the time stated that the proposal had to be “off-topic”. This means it cannot be related to what you do in the lab, and I had gotten deep into territory which I was only familiar with from what I had read. I tried to gesture to the slides, but I could not lift my arm fully. I am not sure if the strange looks I was getting from the committee indicated that they noticed I was acting strangely, or if it was because of my sub-par performance as a PhD student.

Eventually, I was asked to leave the room again while they continued to talk about me behind my back.  By close to three hours, one committee member had to leave and left the other 4 in the room to discuss further. On his way out, he gave me a conciliatory shrug, “it’s not over yet, good luck” and headed off. When I was called back into the room, the verdict was worse than I expected. I received a conditional pass, on the condition that I rewrite and present again in 3 weeks. It took more than I thought I had in me to make the original proposal and that was before the pain. I trudged back to the lab and stared into space before I went home. I could not celebrate because I did not pass, and I could not sleep because the pain did not pass either. I wanted to curl up and die and instead I lied down flat on the basement floor and writhed in pain.

The verdict from the surgeon was no relief either. He told me the nerve damage may be permanent if untreated for too long. He also said mine had gone on for too long and recommended that I immediately get a discectomy followed by either a spinal fusion or an artificial disc replacement. So in addition to needing surgery, I also needed to take my qualifying exam again. It was around this time that word of mouth trickled in about the other members of my cohort passing their exams without any issues, or in some cases with a few rewrites to small portions of their proposals. If nerve pain was an ice cream sundae, then the shame of failure was a cherry on top. The surgeon pushed my date as early as he could, which was right after my rescheduled exam. At least if I failed out of my PhD at the University, I would have my surgery on the company dime before they kicked me out and I lost health insurance.

“If the situation is hopeless, then you’ve got nothing to worry about”. I pushed on through with what had to be done. Having rewritten the entire proposal to be much more like what I did daily in the lab, I passed my exam with the second meeting going smoothly. Many grad students celebrate their advancing to PhD candidacy with drinks, fancy dinner, or a camping trip. I celebrated my exam with plans for spine surgery.